GIFT   OF 
MICHAEL  REESE 


^ 


^y^J^ 


FREUD'S  THEORIES  OF 
THE  NEUROSES 


BY 
Dr.  EDUARD  HITSCHMANN 

of  vienna 


Authorized  Translation  by 
DR.  C.  R.   PAYNE 

With  an  Introduction  by 

ERNEST  JONES,  M.D.,  M.R.C.P. 
of  London 


NEW  YORK 

MOFFAT,  YARD  AND  COMPANY 

1917 


COPTBIGHT,    1917,    BY 

MOFFAT.  YARD  &  COMPANY 
Second  Printing,  April,  1917 


UBRAWf 
Q    ^ 


PREFACE 

The  motives  that  led  me  to  believe  there  is  a 
need  for  a  summary  of  the  Freudian  investiga- 
tions have  only  been  strengthened  during  its 
preparation. 

The  book  is  intended  to  serve  as  an  introduc- 
tion as  well  as  an  incentive  to  the  study  of  Freud's 
works  and  the  application  of  the  psycho-analytic 
methods ;  it  aims  at  separating  from  the  ranks  of 
the  indifferent  and  antagonistic  those  whose  posi- 
tion is  due  to  insufficient  or  erroneous  informa- 
tion ;  finally  it  is  desired  that  this  book  by  point- 
ing out  the  unsolved  problems  of  the  theory  may 
further  their  solution. 

Later  editions  will  have  to  take  into  considera- 
tion the  progress  or  modifications  as  well  as  the 
new  views  arising  from  them.  I  am  greatly  in- 
debted to  Professor  Freud  for  his  revision  and 
many  suggestions  and  to  Dr.  O.  Rank  for  his 
collaboration  in  preparing  the  book. 

Dr.  Eduabd  Hitschmann. 

Vienna, 

Autumn,  1910. 


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1 


TABLE  OF  CONTENTS 

PAGE 

Inthoductiok  to  the  English  Edition  by  Ernest  Jones     .      ix 

Intkoduction XV 

Aim  and  Scope  of  the  Book.  Adherents  and  Opponents. 
Objections.  Objections  opposition  to  the  Theory.  At- 
tempt at  Refutation  or  Explanation  of  Them. 

CHAPTER  I 

General  Theory  op  the   Neuroses 1 

Freud's  Field  of  Work.  General  Pathology.  Classifi-** 
cation  of  the  Neuroses.  Course  of  Development  of  Freud's 
Theory  of  the  Neuroses.  General  Etiology.  Role  of 
Sexuality  and  of  Heredity.  The  Psycho  Sexual  Constitu- 
tion. Cultural  Sexual  Morality.  Reference  to  the 
Therapy. 

CHAPTER  II 

The  True  Neuroses 16 

A»  Neurasthenia:  Clinical  Picture;  Etiology;  Prophy- 
laxis and  Therapy.  B.  Anxiety-Neurosis:  Symptomatol- 
ogy; Etiology;  Theory.  C.  Refutation  of  the  Objections 
to  the  Sexual  Etiology  of  the  True  Neuroses. 

CHAPTER  III 

The    Sexual   Instinct 44 

Existence  and  Significance  of  Sexuality  in  Children ;  Op- 
position to  the  Acceptance  of  this  Discovery.  The  Sexual 
Theory:  A.  Infantile  Sexuality:  1.  Sexuality  of  the  Suckl- 
ing. 2.  Sexuality  in  Children.  3.  Changes  at  Puberty. 
B.  Deviations  of  the  Sexual  Instinct:  Inversion,  Perversion, 
Fetichism,  Sadism,  Masochism,  Exhibitionism,  etc.  C. 
Sexuality  of  Neurotics.  Confirmation  of  the  Theory  by 
Analysis  of  Neuroses  of  Children.  Infantile  "Sexual 
Theories."    Nuclear-Complex  of  the  Neuroses, 


TABLE  OF  CONTENTS 

CHAPTER  IV                                   PAGE 
The  Unconscious 78 

Consciousness  and  the  Unconscious.  Common  Meaning 
of  Unconscious.  Hypnosis  and  Double-Consciousness. 
The  Unconscious  in  Hysteria.  Resistance  and  Repression. 
Genesis  and  Content  of  the  Real  Unconscious.  The  Com- 
plex. The  Free  Association.  The  Association  Experiment. 
Determination  of  All  Mental  Processes.  The  Phenomena 
of  the  Unconscious  in  the  Psychopathology  of  Everyday 
Life.    The  Unconscious  in  Wit  and  Dream  Formation. 

CHAPTER  V 
The  Dream 95 

Chief  Characteristics  of  the  Dream:  Wish- fulfillment. 
Sexual  Erotic  Content.  Dream  Sources.  Dream  Distor- 
tion (Manifest  and  Latent  Content).  The  Dream  Making. 
Interpretation  Technique:  (a)  by  Symbolism,  (6)  by  As- 
sociations.   Technical    Rules.    Typical   Dreams. 

CHAPTER  VI 
Hysteria 121 

Freud's  Position  in  the  Study  of  Hysteria.  Repression 
and  Conversion.  Sexuality  and  Infantilism.  The  Hys- 
terical Mind.  The  Hysterical  Symptom:  Its  Somatic  and 
Psychic  Foundations.  The  Hysterical  Phantasies.  The 
Hysterical  Attack.  Nervous  Disturbances.  Neurotic 
Anxiety  (Anxiety-Dream,  Anxiety-Hysteria,  Phobia). 
Concerning  the  Psychoses. 

CHAPTER  VII 

The  Obsessional  Neurosis 164 

Relation  to  Hysteria.  .Substitution  Instead  of  ConyQ,r- 
sion.  Characteristic  Obsession.  "Nature  anci  Mechanism 
^fffrfie  Obsessional  Neurosis"  (1896).  "Remarks  on  a  Case 
of  Obsessional  Neurosis'*  (1909).  Significance  of  Instinct 
in  Life  (Sadism).  Love  and  Hate;  Obsession  and  Doubt. 
Mechanism  of  Distortion.  Some  Mental  Peculiarities  of 
the  Obsessed. 

CHAPTER  VIII 

Psycho-analytic  Method  of  Investigation  and  Treatment  ,  189 

Its  Peculiarity  (Specific  Therapy).  History  of  the  De- 
velopment of  the  Method.  General  Technique.  Art  of  In- 
terpretation. Indications  and  Contraindications.  The 
Transference.  Refutation  of  the  Objections  to  the 
Method. 


TABLE  OF  CONTENTS 


CHAPTER  IX 

PAGE 

Generat,  Prophylaxis  of  the  Neuroses     .... 

.     .     .  226 

Cultural    Sexual-morality.    Sexual    Education. 
Enlightenment. 

Sexual 

CHAPTER  X 

Application  of  Psycho-axalysis 

...  237 

Importance  of  Psycho-analysis  for  Medicine.  Im- 
portance for  the  Psychology  of  Normal  Individuals  and  for 
Normal  Psychology  (Unconscious,  Dream,  Wit).  Psycho- 
pathology  of  Everyday  Life.  Elucidation  of  the  Psy- 
chology of  Psychopaths,  Criminals,  Artists,  Poets  and 
Geniuses  (Characterology).  Importance  for  the  History 
of  Culture  and  Folk-psychology. 

Chronological  Review  of  the  Freudian  Writings  ....  251 

Freudian  Liteeatuhb  m  Engush  .     .     t     »     .     f     t     ♦     .  255 


INTRODUCTION 

BY 

Ernest  Jones,  M.D.  (Londcm),  M.R.C.P. 

*       (London), 

Dr.  Hitschmann  has  in  this  volume  undertaken 
an  important  task,  namely,  a  synthetic  presenta- 
tion of  the  Freudian  theory.  It  will  on  all  sides 
be  acknowledged  that  the  need  for  this  has  long 
been  felt,  the  reason  being  that  it  is  exceedingly 
difficult  properly  to  grasp  the  significance  of  the 
theory  from  the  reading  only  of  disconnected 
fragments,  which  taken  in  themselves  often  pre- 
sent an  appearance  that  is  far  from  convincing. 

The  especial  difficulty  inherent  in  any  attempt 
to  render  a  connected  description  as  is  here  given 
lies  in  the  fact  that  the  Freudian  theory  repre- 
sents not  a  fixed  philosophic  doctrine  but  a  grow- 
ing body  of  science.  Strangely  enough  this  has 
sometimes  been  made  a  source  of  reproach  to 
Professor  Freud,  as  indicating  a  fluctuating 
change  and  lack  of  stability  in  his  conclusions. 
It  is  certainly  true  that  during  the  gradual  evo- 
lution of  his  methods  and  conclusions,  an  evolu- 
tion which  is  still  in  progress,  he  has  been  led  to 


X  INTRODUCTION 

introduce  various  modifications  into  his  earlier 
views.  These  have  always  been,  however,  of  the 
nature  of  amplifications  rather  than  of  retrac- 
tions, increasing  experience  having  shown  him 
that  some  of  his  earlier  views  were,  though  cor- 
rect so  far  as  they  went,  yet  incomplete  and  at 
times  imperfectly  oriented. 

This  very  evolution  is  surely  evidence  in  itself 
that  the  conclusions  reached  are  based  on  definite 
data  of  experience,  and  represent  no  subjective 
opinions  of  the  author;  a  theory  of  such  novel 
and  intricate  matters  as  unconscious  mental 
processes  should,  on  the  contrary,  arouse  a  justi- 
fiable suspicion  were  it  promulgated  as  being 
complete  and  perfect  from  its  inception.  The 
further  consideration  has  to  be  weighed  that  the 
field  of  Professor  Freud's  investigations  has  un- 
dergone a  remarkable  widening  in  the  course  of 
years.  Confined  at  first  to  the  study  of  the 
neuroses,  it  became  extended  first  to  the  subject 
of  normal  dream  life,  of  the  processes  underlying 
the  production  of  wit,  and  the  development  and 
variation  of  the  instinct  of  sex.  In  the  past  eight 
years  it  has  been  further  extended  so  as  to  com- 
prise on  the  one  hand  various  deviations  from  the 
normal,  such  as  criminality,  certain  psychoses, 
failures  in  mental  functioning  with  healthy  peo- 
ple, the  nature  and  origin  of  sexual  perversions, 
and  on  the  other  hand  an  increasing  number  of 


INTRODUCTION  xi 

more  normal  manifestations,  such  as  the  source 
of  literary  and  artistic  inspiration,  the  evolution 
of  language,  the  structure  and  meaning  of  re- 
ligious, mythological  and  superstitious  beliefs, 
and  the  sources  of  many  other  human  interests 
and  activities,  encroaching  thus  in  ever  widening 
circles  on  the  domain  of  normal  psychology^^ 
These  last  named  extensions.  Dr.  Hitschmann 
has  here  for  the  first  time  given  a  connected  ac- 
count of,  one  which  no  doubt  would  have  been 
less  brief  had  not  the  main  purpose  of  the  book 
been  a  medical  one;  those  who  are  interested  in 
these  important  aspects  of  psycho-analysis  may 
be  referred  to  a  special  journal.  Imago,  which  is 
devoted  to  the  non-medical  applications  of  the 
sub j  ect.  When  one  works  systematically  over  the 
apparently  disconnected  fields  here  mentioned, 
pne  realizes  more  and  more  both  the  breadth  and 
the  unity  of  the  fundamental  conceptions  that 
follow  from  psycho-analytic  investigations.  They 
constitute  an  organic  whole,  and  it  would  seem 
that  the  time  is  now  ripe  for  a  presentation  of 
them  as  such. 

In  carrying  out  this  task.  Dr.  Hitschmann  has 
been  singularly  successful.  Being  in  near  per- 
sonal touch  with  Professor  Freud  himself  and 
also  having  at  his  disposal  an  extensive  psycho- 
analytic experience,  he  is  in  a  position  to  render 
an  especially  faithful  presentation  of  both  the 


xii  INTRODUCTION 

theory  and  the  practice  of  the  subject.  He  has 
subordinated  his  personal  views  and  striven  to 
reproduce  Professor  Freud's  own  as  exactly  as 
possible,  making  indeed  lengthy  quotations  from 
the  latter's  writings  so  as  to  furnish  an  additional 
safeguard  against  any  deflections.  The  book 
should  therefore  be  invaluable  to  those  who  con- 
template making  a  serious  study  of  this  important 
subject,  and  should  serve  as  a  useful  introduction 
to  more  detailed  and  special  publications. 

When  Dr.  Hitschmann  asked  me  to  suggest 
the  name  of  a  translator  for  his  book,  I  must  con- 
fess that  I  felt  at  a  considerable  loss,  for  it  was 
clear  to  me  that  the  task  would  be  no  easy  one. 
German  is  a  harder  language  to  translate  from 
than  French,  and  as  most  of  the  sentences  have 
to  be  entirely  reconstructed,  the  translator  must 
have  a  thorough  knowledge  both  of  German  and 
of  the  subject-matter,  especially  so  in  such  a  book 
as  the  present  one  where  so  much  material  is 
tightly  packed  into  a  relatively  small  space. 
Further,  not  only  had  English  equivalents  to  be 
found  for  the  new  terms  that  inevitably  accom- 
pany new  ideas,  but  so  much  of  the  thought  was 
novel  and  strange  that  in  order  to  make  the  trans- 
lation intelligible  especial  care  had  to  be  taken 
in  couching  the  language  in  an  unambiguous, 
lucid  and  accurately  grammatical  form,  a  re- 
sponsibility not  always  realized  by  translators  of 


INTRODUCTION  xiii 

scientific  works.  I  had  the  good  fortune,  how- 
ever, of  being  able  to  enlist  the  energies  of  Dr. 
Payne,  who  has,  as  I  know  from  a  personal  ac- 
quaintance with  his  work,  a  thorough  knowledge 
and  understanding  of  psycho-analysis  and  whose 
care  in  rendering  the  precise  meaning  of  the  orig- 
inal combined  with  a  rare  happiness  of  expression 
will  commend  itself  to  all  his  readers.  Dr. 
Payne  has  further  enriched  the  book  with  a  num- 
ber of  footnotes  that  elucidate  particularly  diffi- 
cult passages  in  the  text,  and  has  added  bibli- 
ographical references  to  some  of  the  rapidly  accu- 
mulating literature  in  English.  May  his  trans- 
lation win  the  success  it  is  justly  entitled  to. 

Ernest  Jones. 


INTRODUCTION 

Aim  and  Scope  of  the  Book.  Adherents  and  Oppo- 
nents. Objections  and  Opposition  to  the  Theory. 
Attempt  at  Refutation  or  Explanation  of  Them. 

The  following  condensed  presentation  of  the 
present  status  of  Freud's  theory  of  the  neuroses 
is  justified  in  the  first  place  by  the  difficulty  of 
the  subject,  the  constantly  increasing  extent  of 
the  publications  dealing  with  it  and  the  fact  that 
the  lack  of  a  systematic  arrangement  of  Freud's 
writings  has  made  the  first  perusal  and  study  of 
them  a  hard  task.  Freud  has  never  pretended  to 
offer  a  completely  elaborated  theory  of  the  neu- 
roses ;  indeed  he  could  not  have  done  so,  since  he 
proceeded  from  practical  experience  which  of 
necessity  could  only  develop  and  deepen  by  de- 
grees. A  theory,  complete  and  well  rounded  at 
the  beginning,  could  only  be  the  product  of  spec- 
ulation, which  might  indeed  be  suitable  for  a 
philosophical  system  but  not  for  a  medical  study. 
Nevertheless,  the  foundation  and  framework  of 
the  theory  are  already  erected  so  that  it  is  time  to 
attempt  a  provisional  review  of  the  whole.  It  is 
obvious  that  this  synthetic  presentation  avoids 

XV 


xvi  INTRODUCTION 

either  filling  in  or  concealing  the  necessary  gaps ; 
on  the  contrary,  it  will  call  attention  to  them  and 
thus  point  out  the  problems  still  to  be  solved. 
The  book  is  meant  to  be  purely  a  review;  it  there- 
fore uses  many  of  Freud's  own  words  and  has 
especially  endeavored  to  place  the  empirical 
foundations  of  his  investigations  in  the  fore- 
ground. It  has  in  view  the  arousing  of  interest 
in  the  study  and  examination  of  this  important 
method  among  distant  circles  of  medical  men  both 
in  the  clinic  and  in  private  practice,  and  hopes  in 
this  way  to  be  able  to  show  the  general  validity 
of  it.  Where,  but  a  short  time  ago  only  a  small 
band  of  zealous  colleagues  were  gathered  around 
Freud,  now  in  recent  years  the  Freudian  doc- 
trine has  found,  especially  in  foreign  countries,  an 
echo  of  agreement  and  a  group  of  influential 
adherents.^  Still,  wide  circles  of  the  medical 
profession  either  remain  indifferent  or  are  led 
astray  and  alarmed  by  the  extreme  attacks  of  cer- 
tain fanatical  opponents.  It  is  imperative,  there- 
fore, to  begin  by  exposing  the  motives  which  lie 
at  the  bottom  of  so  much  of  the  opposition  to  an 
unprejudiced  examination  of  these  new  and  orig- 
inal conceptions,  at  the  same  time  refuting  some 

iThis  applies  especially  to  the  Swiss  school  with  Bleuler  and 
Jung  at  its  head.  Compare  the  important  works  of  this  school 
in  the  bibliography  of  the  Jahrhuch  filr  psychoanalytische  und 
psychopathologische  ForscTiungen,  published  under  the  supervision 
of  Bleuler  and  Freud  and  edited  by  Jung,  Vol.  II,  1910. 


INTRODUCTION  xvii 

objections  whicH  often  enough  arise  from  only  an 
incomplete  understanding  of  the  theories  which 
they  oppose. 

Naturally,  one  can  only  do  justice  to  the 
Freudian  doctrines,  which  have  in  no  way  been 
evolved  from  theories  but  slowly  developed  from 
painfully  acquired  experience,  when  he  has  tried 
out  in  practice  the  method  of  mental  investiga- 
tion (psycho-analysis)  derived  from  them.  The 
difficulty  which  is  experienced  in  attempting  this 
has  many  causes.  In  the  first  place,  it  may  be 
explained  by  the  fact  that  for  the  present  gener- 
ation of  physicians  educated  in  the  chemico- 
anatomico-pathological  school  it  is  almost  impos- 
sible to  allow  a  proper  place  to  psychic  causej 
of  disease.  -I^t  is  customary  to  be  satisfied  wit! 
the  hereditary  and  constitutional  theories  of  the 
neuroses.  By  far  the  greatest  and  most  universal 
opposition  raised  against  the  Freudian  doctrines 
has  been  because  of  the  disclosure  of  an  unf  aihng 
sexual  agency  in  the  causation  of  neurotic  man- 
ifestations. Here  the  resistance,  a  normal  one, 
lies  in  the  nature  of  the  thing  itself,  since  healthy 
and  slightly  neurotic  individuals  are  inclined  for 
intelligible  reasons  to  deny  the  paramount  im- 
portance of  sexuality:  the  healthy,  because  it  con- 
stitutes no  problem  for  them;  the  others  because 
of  their  imconscious  need  to  spread  a  veil  over 
their  own  weaknesses. 


xviu  INTRODUCTION 

Unfortunately,  physicians  in  their  personal 
relation  to  the  question  of  sexual  life  have  not 
been  given  any  preference  over  the  rest  of  the 
children  of  men  and  many  of  them  stand  under 
the  ban  of  that  combination  of  prudery  and  lust 
which  governs  the  attitude  of  most  cultivated 
people  in  sexual  matters.  Even  those  whose 
medical  experience  will  not  allow  them  to  escape 
from  the  observation  that  sexuality  plays  an  im- 
portant role  in  the  neuroses  deny  the  universal 
application  of  this  experience  and  dispute  the 
conclusion  that  in  every  case  the  exciting  or 
decisive  causes  must  be  of  a  sexual  nature. 
Against  this  attitude  is  Freud's  assertion  that  his 
experience  of  many  years  has  as  yet  shown  no 
exception  to  this  rule.  It  will  thus  be  necessary 
to  wait  and  see  if  in  the  use  of  the  method  of  in- 
vestigation developed  by  Freud  any  exceptions 
may  be  proven.^ 

In  strange  contrast  to  this  reproach  of  unjusti- 
fied generalizations  is  brought  forward  from 
another  side  the  assertion  that  Freud's  teaching 
brings  forth  absolutely  nothing  new,  but  merely 
reiterates  the  old  naive  folk-opinion  which 
brought  the  affections  into  close  connection  with 
nervous  and  mental  diseases.     While  Freud  has 

2  One  may  compare  with  this  the  course  of  development  of  the 
etiological  views  regarding  tabes  dorsalis  where  now  syphilis  is 
considered  an  invariable  antecedent. 


INTRODUCTION  xix 

acknowledged  with  satisfaction  these  supporters 
who  are  in  no  way  to  be  despised,  still  it  must  be 
kept  clearly  in  mind  what  a  distance  separates 
his  exact  scientific  methods  and  demonstrations 
from  these  primitive  and  naive  folk-beliefs.  This 
applies  especially  to  the  question  of  whether  or 
not  dreams  can  be  interpreted;  that  dreams  are 
susceptible  of  a  genuine  scientific  investigation 
the  scholastics  deny ;  against  this  learned  opinion, 
Freud's  splendid  work  has  produced  the  proof 
that  dreams  have  a  real  meaning  in  the  sense  of 
the  primitive  folk-belief.  Whoever  condescends 
to  interpret  his  own  or  another's  dreams  accord- 
ing to  the  Freudian  principles  will  soon  bow  re- 
spectfully before  this,  perhaps  the  most  impor- 
tant of  Freud's  contributions,  and  arrive  at  iden- 
tical results.^  On  the  other  hand,  the  common 
sentiment  of  all  people  in  favor  of  free-will  in 
mental  processes  is  in  direct  opposition  to  the 
recognition  by  the  Freudian  theory  of  a  strict 
determinism  of  every  psychic  process;  likewise, 
the  ignorance  of  symbolism  which  is  indispensable 
for  dream  and  symptom  interpretation  creates  a 
doubt  of  its  reality  and  justification.^  Finally, 
much  opposition  has  been  manifested  against  the 

3  Compare  for  example  Eberhard  Buchner.  "Traum  und 
Traumdetung,"  in  Frankfurter  Zeitung  of  Jan.  30,  1910. 

4  Both  of  these  objections  which  arise  from  the  nature  of  things 
will  be  made  intelligible  and  refuted  in  the  course  of  the  pres- 
entation. 


XX  INTRODUCTION 

numerous  observations  which  Freud  has  reported 
concerning  the  early  sexual  expressions  of  chil- 
dren which  until  now  were  quoted  by  others 
merely  as  odd  or  as  frightful  examples  of  pre- 
cocious depravity.  Here  again  any  one  who  has 
made  similar  observations  can  be  convinced  of  the 
universality  of  these  occurrences;  indeed  one 
should  not  spare  himself  the  trouble  of  directing 
his  attention  to  such  unpleasant  signs. 

A  part  of  the  antagonism  is  explained  by  the 
fact  that  Freud  is  compelled  by  his  investiga- 
tions to  use  the  word  sexuality  in  a  broader  sense 
than  usual,  giving  it  about  the  same  meaning  as 
the  word  *'love"  in  the  German  language,  thus 
asserting  the  underlying  unity  of  all  love  from 
the  grossly  sensual  sexual  intercourse  to  the  most 
unassuming  exhibition  of  affection.  The  use  of 
the  term  sexuality  in  the  Freudian  sense  is  justi- 
fied psychologically  and  brings  forward  a  most 
fruitful  point  of  view.  It  is  also  obvious  that  not 
only  the  actual  activities  of  the  sexual  life  but 
also  its  phantasies  are  to  be  considered.  Freud 
refuses  to  countenance  the  narrow  and  degraded 
use  of  the  word  sexuality  on  which  a  part  of  the 
antagonism  rests. 

A  condition  which  has  hitherto  really  hindered 
to  a  certain  degree  the  diffusion  and  confirmation 
of  Freud's  views  regarding  the  neuroses  is  the 
fact  that  so  far  there  is  no  systematic  and  com- 


INTRODUCTION  xxi 

plete  exposition  of  the  method  of  the  analysis ;  in 
medicine,  one  is  usually  accustomed  to  acquire  the 
method  and  thus  be  in  a  position  to  test  it  at  &st 
hand.  Further,  a  practical  demonstration  of  the 
method,  a  public  psycho-analysis  as  it  were,  is  im- 
possible. Of  course,  it  is  always  possible  for 
those  really  interested  to  acquire  the  technique  by 
personal  contact  with  Freud  and  by  their  own 
subsequent  exertions  which  as  a  matter  of  fact 
many  have  succeeded  in  doing.  On  the  other 
hand,  the  technical  difficulties  in  the  way  of  repro- 
ducing the  analyses  render  learning  from  exam- 
ples a  hard  task.  Freud's  relatively  few  pub- 
lished analyses^  are  only  put  forth  in  frag- 
mentary form  because  their  complete  reproduc- 
tion would  take  an  enormous  space  and  bring  the 
physician  into  conflict  with  his  duty  of  discretion. 
On  the  other  hand,  individual  details  torn  from 
their  context  lose  the  greatest  part  of  their  power 
to  convince.  For  these  reasons,  the  present  ex- 
position cannot  cite  case  records.  For  the  rest, 
one  could  not  by  innumerable  examples  or 
brochures  convince  those  who  will  not  allow  them- 
selves to  be  convinced,  while  those  who  have 

6  Freud,  "Bruchstiick  einer  Hysterieanalyse"  (Literature  index 
No.  21),  "Analyse  der  Phobie  eines  fiinfjahrigen  Knaben" 
(Jahrb.  I),  "Bemerkungen  iiber  einen  Fall  von  Zwangsneurose" 
(ebenda).  Further,  compare  L.  Binswanger,  "Versuch  einer 
Hysterieanalyse"  (ebenda)  as  well  as  other  articles  in  the  Jahr^ 
buck  with  brief  analyses. 


xxii  INTRODUCTION 

already  gained  a  conviction  of  the  objective  real- 
ity of  the  unconscious  pathogenic  material 
already  possess  in  their  own  experience  the  means 
of  confirming  the  progress  in  the  realm  of  the 
Freudian  theory  of  the  neuroses.  They  will  also 
be  in  the  best  position  to  oppose  those  all  too  nu- 
merous individuals  who  will  always  repeat  the 
assertion  that  much  of  the  pathogenic  sexual 
material  which  the  analysis  uncovers  in  the 
patients  examined  has  been  suggested  to  them. 
He  who  has  hstened  to  such  a  patient  calmly  and 
without  prejudice  for  hours  at  a  time  will  be 
easily  convinced  that  every  neurotic  is  full  of  the 
subject  and  is  only  waiting  to  confide  to  an  ap- 
preciative listener  the  secrets  carefully  guarded 
from  others,  even  from  those  nearest  him.  Only 
by  the  way  of  psycho-analysis  can  the  therapeutic 
results  be  attained  which  are  in  no  way  connected 
with  the  personality  and  authority  of  an  indi- 
vidual as  many  skeptically  assert,  but  lie  in  the 
correct  conception  and  utilization  of  the  method 
and  its  technique. 

In  the  attempt  to  justify  by  plausible  objec- 
tions the  untenable  antipathy  against  this  new- 
fashioned  and  in  no  way  easily  acquired  system, 
the  reproach  has  been  raised  against  Freud's  con- 
clusions that  they  are  not  trustworthy  because  in 
the  course  of  years  they  have  undergone  more 


INTRODUCTION  xxiii 

than  one  modification.  It  is  really  scarcely 
necessary  to  defend  against  this  reproach  an  in- 
vestigator who  has  carried  through  so  revolution- 
ary a  life  work,  many  years  without  aid  or  encour- 
agement from  his  colleagues.  Freud  himself  has 
dismissed  it  with  these  words:  "Whoever  be- 
lieves in  the  development  of  human  intelligence 
will  hear  without  surprise  that  I  have  learned  to 
discard  a  part  of  the  opinions  once  put  forth,  to 
modify  another  part.  Still,  I  have  been  able  to 
hold  the  greatest  part  unchanged  and  need  retract 
absolutely  nothing  as  entirely  wrong  and  quite 
worthless."  For  the  intelligent,  the  gradual  evo- 
lution of  the  Freudian  doctrines  is  rather  the 
proof  of  a  remarkable  conception  in  the  begin- 
ning, which  remains  essentially  unchanged  and 
only  undergoes  a  more  detailed  elaboration  in 
certain  parts.  This  progressive  development 
gives  the  best  assurance  for  the  belief  that  this 
theory  is  nothing  else  than  the  accunmlation  of 
continued  and  deepening  experience.  It  should 
in  no  way  be  denied  that  there  are  still  to-day 
many  points  in  the  Freudian  field  of  work  in  part 
unexplained,  in  part  not  sufficiently  verified  and 
that  it  will  require  not  less  than  a  generation  of 
strenuous  labor  to  carry  the  system  to  its  full 
completion.  It  may  be  foreseen  that  the  con- 
tents of  the  Freudian  philosophy  will  then  be  an 


xxiv  INTRODUCTION 

indispensable  part  of  medical  education  and  that 
the  science  of  psycho-analysis  in  the  hands  of  the 
next  generation  of  physicians  will  succeed  to  an 
indispensable  practical  importance. 


FREUD'S  THEORY  OF  THE 
NEUROSES 

CHAPTER  I 

GENERAL  THEORY  OF  THE   NEUROSES 

Freud's  Field  of  Work.  General  Pathology.  Clas- 
sification of  the  Neuroses.  Course  of  Development  of 
Freud's  Theory  of  the  Neuroses.  General  Etiology. 
Role  of  Sexuality  and  of  Heredity.  The  Psychosexual 
Constitution,  The  Cultural  Sexual  Morality.  Refer- 
ence to  the  Therapy. 

The  field  of  Freud's  work  comprises  the 
neuroses  in  the  narrower  sense  as  well  as  certain 
closely  related  psychoses,  such  as  paranoia,  acute 
hallucinatory  confusion,  etc.  Formerly,  numer- 
ous clinical  pictures  were  included  in  the  term 
neuroses  from  which  many  have  been  separated 
by  the  progress  of  the  study  of  the  blood-forming 
organs,  for  example,  Basedow's  disease  and 
tetany,  while  on  the  other  hand,  others  have  been 
classified  as  infections,  for  example,  chorea. 
Thus,  the  term  neurosea.has  now  been  limited  to 
/neurasthenia,   hysteria  and  the  compulsion   or^  ^'  ( 


2        FFiEUD'S  THEORY  OF  THE  NEUROSES 

obsessional  neurosis  (Zwangsneurose).  Accord- 
ing to  Freud's  opinion,  the  neuroses  deserve  the 
name  sexual-neuroses,  since  for  these  clinical  pic- 
tures the  chief  etiological  factors  may  be  proven 
to  lie  in  the  psychosexual  sphere.  In  the  field 
of  neurasthenia,  the  Freudian  investigation  has 
yielded  a  classification  of  great  theoretical  im- 
portance and  practical  significance.  In  a  classi- 
cal study,^  Freud  has  separated  from  the  vague 
term  neurasthenia  the  "toxiety-neurosis"  and 
further  sharply  marked  off  a  symptom-complex 
as  real  or  true  neurasthenia.  He  calls  these  two 
clinical  pictures  true  neuroses  because  their  cause 
lies  in  the  present  abnormal  condition  of  the 
sexual  function  of  the  individual  and  in  oppo- 
sition to  these  he  calls  hysteria  and  the  obsessional 
neurosis,  psychoneuroses.  In  these  latter,  the 
real  causative  factors  in  contrast  to  those  of  the 
true  neuroses  belong  not  to  the  actual  sexual  life 
but  to  a  long  past  period  of  life  in  early  child- 
hood,. Further,  these  infantile  experiences  and 
impressions  which  only  later  become  actively 
pathogenic  turn  out  to  belong  without  exception 
to  the  erotic  life  which  is  generally  though  er- 
roneously beheved  to  be  completely  neghgible  in 

I  ^i"uber    die    Berechtigung,    von    der    Neurasthenic    einen    be-'> 
jstimfnten    SvTiiptomenkomplex    als    *Angstneurose'    abzutremieji/y 
iLit^  No.  4.  '  '  ' 

2  In  the  following  presentation,  neurasthenia  and  hysteria  will 
be  used  as  fhe  best  known  examples  of  their  kind. 


:.,^'t^7 


GENERAL  THEORY  OF  NEUROSIS     3 

the  child.  Thus  in  every  case  of  neurosis,  a  sex- 
ual etiology  was  revealed;  in  neurasthenia,  the 
agencies    were    of  a    physical    nature,    in    the 

j^sychoneuroses,  of  an  infantile  nature.  A  second 
essential  difference  between  these  two  groups  of 
nervous  maladies  is  to  be  sought  in  the  fact  that  in 
the  true  neuroses  the  disturbances  (symptoms) 
may  find  expression  in  physical  or  mental  mani- 
festations which  seem  to  be  of  a  toxic  nature ;  they 
are  similar  to  the  phenomena  accompanying  an 
excess  or  deficiency  of  certain  nerve  poisons. 
These  neuroses,  formerly  grouped  mostly  under 
neurasthenia,  can  be  produced  by  certain  inju- 
rious influences  of  the  sexual  life  without  any 
necessary  hereditary  predisposition;  indeed  the 
form  of  the  malady  corresponds  to  the  kind  of 
injurious  influence  so  that  frequently  one  can 
infer  the  special  sexual  etiology  merely  from  the 
clinical  picture  presented.  With  the  psychoneu- 
roses  on  the  other  hand,  the  influence  of  heredity 
is  more  important,  the  original  cause  less  evident. 
A  special  method  of  investigation  which  will  be 
described  later  as  psycho-analysis  has,  however, 
allowed  the  fact  to  be  recognized  that  the  symp- 
toms of  the  disorders  (hysteria,  obsessional 
neurosis,  etc.)  are  psychogenic,  depending  on  the 
activity  of  unconscious    ( repressed )    idea-com- 

^Igx^i^^,, ,.  This  same  method  has  also  recognized 
these  complexes  and  shown  them  to  be  universally 


4   FREUD'S  THEORY  OF  THE  NEUROSES 

of  a  sexual  erotic  content;  they  arise  from  the 
sexual  needs  of  individuals  ungratified  in  the 
broadest  sense  of  the  word  and  afford  them  a 
kind  of  substitute  gratification. 

The  value  of  the  theoretical  distinction  betvreen 
the  toxic  (true)  neuroses  and  the  psychogenic 
neuroses  is  not  diminished  by  the  fact  that  in 
most  nervous  persons  disturbances  due  to  both 
sources  may  be  observed.  Such  mixed  cases  are 
very  frequent;  thus,  the  obsessional  neurosis  is 
often  associated  with  neurasthenia,  anxiety-neu- 
rosis with  hysteria  (compare  later  "anxiety- 
hysteria")  .  In  all  these  cases,  a  mixed  and  com- 
bined etiology  in  the  sense  explained  later  is 
found  without  exception. 

While  it  was  just  now  stated  that  those  two 
great  groups  of  diseases  were  the  original  field  of 
Freud's  work,  it  must  be  emphasized  that  for 
about  fifteen  years  Freud  has  not  had  opportunity 
to  continue  his  investigation  of  the  true  neuroses, 
hence  this  part  of  the  theory  has  not  experienced 
a  further  expansion.  The  important  progress 
which  the  comprehension  of  the  nature  of  the 
psychoneurotic  troubles  has  made  in  the  mean- 
time will  place  their  relation  to  the  true  neuroses 
in  a  somewhat  different  light  and  it  will  probably 
necessitate  a  revision  in  this  field  in  the  near  fu- 
ture. The  more  limited  field  of  Freud's  work 
is  constituted  by  the  psychonem^otic  forms,  espe- 


GENERAL  THEORY  OF  NEUROSIS     5 

cially  hysteria  and  the  obsessional  neurosis,  and 
it  is  exceedingly  instructive  to  follow  the  steps 
in  the  development  of  the  nucleus  of  the  Freud- 
ian doctrine  if  one  wishes  to  appreciate  the  full 
extent  and  value  of  his  theory  of  the  etiological 
significance  of  the  psychosexual  agencies  for  the 
neuroses. 

As  a  pupil  of  Charcot  in  Paris  in  1885-1886, 
Freud  received  important  incentives  to  investi- 
gation.^ Prominent  among  these  was  the  step 
by  which  Charcot  surpasssed  the  level  of  his  orig- 
inal conception  of  hysteria  and  assured  himself 
the  fame  of  being  the  first  to  explain  this  enig- 
matical malady,  a  fact  of  great  significance  for  the 
further  investigations  in  this  field.  While  Char- 
cot was  engaged  in  the  study  of  the  hysterical 
paralyses  which  follow  dreams  the  idea  came  to 
him  to  reproduce  these  paralyses  artificially  and 
to  this  end  he  made  use  of  hysterical  patients 
whom  he  brought  into  the  somnambulistic  state 
by  hypnosis.  He  succeeded  in  proving  that  these 
paralyses  may  be  the  result  of  ideas  which  have 

3  Compare  Freud's  obituary  notice  on  Charcot,  Lit.  No.  3S, 
While  lecturer  in  Vienna  University,  Freud  translated  into  Ger- 
man the  most  important  works  of  his  French  master,  J.  M.  Char- 
cot, "Poliklinische  Vortrage,"  School-year  1887-88.  "Neue 
Vorlesungen  Uber  die  Krankheiten  des  Nervensystems,  indesondere 
iiber  Hysteric."  H.  Bernheim,  "Die  Suggestion  und  ihre  Heil- 
wirkung."  "Neue  Studicn  iiber  Hypnotismus  Suggestion,  und 
Psychotherapie."  Collected  by  the  press  of  F.  Deuticke,  Vienna 
and  Leipzic.  \ 


6        FREUD'S  THEORY  OF  THE  NEUROSES 

gained  the  mastery  of  the  patient's  brain  in  mo- 
ments of  special  disposition.  Thus  was  the  mech- 
anism of  an  hysterical  symptom  elucidated  for 
the  first  time  and  this  incomparably  beautiful 
piece  of  clinical  investigation  enabled  Charcot's 
pupil,  P.  Janet,  to  pave  the  way  for  a  deeper 
penetration  into  the  peculiar  psychic  processes 
of  hysteria.  This  example  was  followed  by 
Breuer  and  Freud  who  succeeded  in  sketching  a 
psychological  theory  of  hysteria  in  their  jointly 
pubhshed  "Studies  in  Hysteria"  ( 1895 ) .  In  the 
years  1880-1882,  Breuer  had  observed  a  note- 
worthy case  of  hysteria  which,  in  so-called 
hypnoidal  states,  revealed  to  the  attending  phy- 
sician those  psychic-traumatic  experiences  which 
had  brought  about  the  individual  hysterical 
symptom.  Thereby  appeared  the  entirely  new 
and  surprising  fact  that  the  individual  hysterical 
symptoms  disappear  when  the  memory  of  the 
event  which  caused  them  is  successfully  brought 
to  clear  consciousness,  at  the  same  time  arousing 
its  accompanying  effect  and  having  the  patient 
describe  the  event  in  all  possible  detail  and  give 
the  effect  expression  in  words.  Following  this 
classical  observation  of  Breuer's,  as  you  might  say 
the  first  psycho-analysis,  Freud  applied  the  ca- 
thartic method  to  a  series  of  cases  with  success. 
Breuer  and  Freud  arrived  at  conclusions  which 
permitted  of  bridging  the  gap  between  the  trau- 


GENERAL  THEORY  OF  NEUROSIS     7 

matic  hysteria  of  Charcot  and  the  general  non- 
traumatic variety.     Their  conception  was  that     I 
the  hysterical  symptoms  are  the  continued  activ-     | 
ities  of  mental  traumas,  the  accompanying  effects    ^ 
of  which  have  been  separated  by  special  conditions    ^ 
from  the  conscious  mental  processes  and  are  ac-     \ 
cordingly  in  a  position  to  attain  an  abnormal     ^ 
path  to  bodily  innervation   (conversion).     The 
terms  "pent-up  effect,"  "conversion,"  "to  abre- 
act"  sum  up  the  characteristics  of  this  view.     It 
showed  these  painful  experiences  "repressed  into 
the  unconscious,"  the  effects  of  the  original  idea 
not  abreacted  as  "pent-up";  only  by  the  complete 
expression  of  this  idea  in  words  could  the  patho- 
genic activity  of  the  old  memory  be  broken.     If 
the  requisite  conditions  for  conversion  are  no*t  at 
hand  in  a  person,  then  the  idea  separated  from  its 
effect  may  remain  separated  from  all  associations 
in  consciousness;  the  emotion  thus  set  free  may 
become  attached  to  other  not  unbearable  ideas 
and  these  from  this  false  association  become  obses- 
sions in  the  broader  sense  of  the  term  (substitu- 
tion).    Hysteria   and  obsessional  neurosis   are 
thus  both  to  be  considered  as  cases  of  unsuccessful 
defense. 

In  the  further  investigation  of  the  psycho- 
neuroses  to  which  Freud  now  devoted  himself  ex- 
clusively, he  found  upon  a  more  detailed  study  of 
the  causative  psychic  traumas  from  which  the 


8        FREUD'S  THEORY  OF  THE  NEUROSES 

hysterical  symptoms  were  supposed  to  be  derived 
that  these  original  scenes  which  had  appeared  to 
possess  etiological  importance  must  sometimes  be 
absolved  from  being  the  determining  factor  and 
the  traumatic  force  which  occasioned  the  disease. 
The  "traumatic  experience"  thus  lost  its  supreme 
importance  and  Freud  found  through  continued 
analytic  work  in  the  associated  memories  of  the 
patient  that  no  symptom  of  an  hysteric  could 
arise  solely  from  an  actual  experience,  but  that  in 
every  case  a  memory  awakened  by  Association  of 
an  earlier  traumatic  experience  usually  belonging 
to  the  time  of  puberty,  which  had  not  at  that  time 
caused  trouble,  cooperated  in  the  causation  of  the 
symptom.  A  further  result  of  this  later  analytic 
work  was  the  discovery  that  from  whatever  case 
or  whatever  symptom  one  wished  to  start,  he 
finally  came  without  exception  to  the  field  of 
sexual  experience.  Herewith  was  revealed  for 
the  first  time  an  etiological  condition  of  an  hyster- 
ical symptom. 

But  experiences  recovered  with  so  much 
trouble,  extracted  from  the  mass  of  old  memories, 
seemingly  the  final  traumatic  events,  although 
they  had  the  two  characteristics  of  sexuality  and 
puberty  in  common,  proved  themselves  to  be  very 
disparate  and  of  different  value  so  that  further 
investigation  was  demanded.  It  was  finally 
revealed  that  behind  the  sexual  erotic  events  of 


GENERAL  THEORY  OF  NEUROSIS     9 

puberty  are  still  more  far-reaching  experiences  of 
infantile  life,  which  are  also  of  sexual  content  but 
of  far  more  uniform  kind  than  the  previously 
revealed  scenes  occurring  at  puberty.  These  in- 
fantile experiences  evince  their  effect  in  only  the 
slightest  degree  at  the  time  when  they  happen; 
far  more  important  is  the  later  effect,  which  finds 
expression  only  in  later  periods  of  maturity. 
Since  these  infantile  experiences  of  sexual  con- 
tent can  produce  a  psychic  effect  only  by  the  aid 
of  the  memory,  here  is  revealed  the  insight  that 
hysterical  symptoms  never  arise  without  the  co- 
operation of  the  memory.  Hysterical  patients 
suffer  from  "reminiscences."  At  the  bottom  of 
every  case  of  hysteria  are  found  one  or  more 
events  of  premature  sexual  experience  which  be- 
long to  earliest  youth ;  these  may  be  reproduced 
in  memory  by  persevering  analytic  work  even  after 
decades  have  intervened.  At  that  time,  these 
traumatic  experiences  were  erroneously  limited 
to  neurotics;  it  soon  became  evident,  however, 
that  such  experiences  were  often  consciously  re- 
membered by  individuals  who  remained  perfectly 
healthy  afterwards,  hence  the  specific  etiological 
agent  in  the  causation  of  the  neurotic  symptoms 
could  not  lie  in  this  circumstance. 

By  a  penetrating  investigation  of  the  sexual 
life  of  the  first  years  of  childhood  this  note- 
worthy and  very  instructive  error  was  exposed 


10      FREUD'S  THEORY  OF  THE  NEUROSES 

and  by  a  deepened  insight  into  the  constitutional 
factors,  overcome.  Freud  had  previously  re- 
vealed in  the  "Drei  Abhandlungen  zur  Sexual- 
theorie"  ^  the  whole  polymorphous  fullness  of  the 
normal  infantile  sexual  life  with  its  germs  of 
disease  and  abnormality.  Thereby  infantilism 
of  sexuality  took  the  place  of  the  originally  over- 
rated infantile  sexual  traumas.  And  as  the  sex- 
ual experiences  of  childhood  reported  by  patients 
turned  out  repeatedly  to  be  the  products  of  later- 
formed  phantasies  from  the  eroticism  of  puberty 
concerning  earlier  childhood,  the  importance  of 
the  preponderating  erotic  phantasy-life  for  the 
breaking  out  of  a  neurosis  came  to  the  fore- 
ground. When  Freud  had  finally  succeeded  in 
analyzing  a  child-neurosis  in  state  of  formation 
there  was  revealed  the  decisive  influence  of  the 
family  constellation  on  the  content  and  intensity 
of  the  child's  affections  as  well  as  for  the  later 
possibilities  of  development.  The  nature  and 
degree  of  the  psychic  fixation  of  the  growing  child 
on  the  parents  and  brothers  and  sisters,  as  well  as 
on  the  related  problems  of  birth  and  procreation, 
disclose  themselves  more  and  more  clearly  as  the 
essential  nuclear  complex  of  the  neuroses.  To 
the  formation  of  a  neurosis  from  this  nuclear 
complex,  which  is  also  present  in  normal  indi- 

4  Translation  by  Brill  in  Monograph  Series  of  Journal  of  Ner- 
vous and  Mental  Disease. 


GENERAL  THEORY  OF  NEUROSIS    11 

viduals,  belong  in  exquisite  fashion,  besides  quan- 
titative transgressions,  a  hereditary  predisposition 
which  Freud  has  described  in  a  narrower  sense  as 
the  psychosexual  constitution.  In  this  decisive 
importance  of  the  instinctive  life  and  its  psycho- 
sexually  conditioned  disharmonies  there  has  been 
attained  a  provisional  ultimate  source  for  the 
later  formation  of  the  neurosis. 

When  Freud  appeared  on  the  scene,  heredity 
constituted  the  most  important  presupposition 
of  the  neurosis.  He  could  thus  with  justice  ap- 
ply himself  at  first  to  the  exciting  agencies ;  in  this 
connection,  he  has  not  overlooked  but  repeatedly 
called  attention  to  the  fact  that  besides  the  agen- 
cies in  the  psychosexual  field,  the  etiology  of  the 
neuroses  may  be  conditioned  both  by  inheritance 
and  by  a  special  constitution  and  that  the  neu- 
roses, like  all  other  diseases,  have  complex  causes. 
Though  more  recently  the  theory  of  an  hereditary 
predisposition  has  undergone  a  certain  abridg- 
ment, still  there  is  no  doubt  that  there  are  neuro- 
pathic families  in  which  an  hereditary  taint  can  be 
clearly  traced.^     Freud  thus  assumes  that  the  he- 

e  Freud  has  emphatically  pointed  out  more  than  once  that  in 
more  than  half  of  his  cases  of  severe  hysteria,  obsessional  neu- 
"^J^^  rosis,  etc.,  treated  by  psychotherapy,  syphilis  in  the  father  before 
marriage  was  to  be  proven.  Not  that  the  later  neurotic  children 
bore  physical  signs  of  hereditary  lues  but  that  in  these  cases  the 
abnormal  psycho-sexual  constitution  could  be  observed  as  the  last 
offshoot  of  luetic  inheritance. 


12      FREUD'S  THEORY  OF  THE  NEUROSES 

redity  finds  expression  in  a  peculiar  psychosexual 
constitution  of  the  individual  which  asserts  itself 
in  an  abnormally  strong  and  many-sided  instinc- 
tive life  and  a  consequent  sexual  precocity.  This 
renders  difficult  the  later  desirable  subjection  of 
the  sexual  instinct  to  the  higher  mental  powers, 
its  adaptation  to  the  prevailing  cultural  demands 
and  strengthens  the  obsessional  character  which 
the  psychic  rejjresentation  of  this  instinct  lays 
claim  to.  This  early  and  excessive  development 
of  the  sexual  instinct  brought  about  by  constitu- 
tional conditions  can  only  be  counteracted  by  an 
abnormal  amount  of  efferent  repressive  effort 
(sexual  repression) ;  the  psychological  analysis 
shows  further  how  to  solve  the  contradictory 
mysteriousness  of  hystyeria  by  the  perception  of 
two  opposing  forces,  ya  too  severe  sexual  absti- 
nence and  ail/excessive  sexual  need.  The  occa- 
sion for  the  onset  of  the  disease  in  the  hysterically 
disposed  person  arises  when,  on  accoimt  of  the 
progressive  internal  maturing  process  or  of  ex- 
ternal events,  the  real  sexual  demands  earnestly 
assert  themselves.  Between  the  compulsion  of 
the  instinct  and  the  opposing  force  of  sexual 
denial,  the  way  is  prepared  for  the  malady,  which 
does  not  solve  the  conflict  but  seeks  to  escape  it 
by  changing  the  libidinous  strivings  into  symp- 
toms. The  manifold  varieties  and  the  different 
possibilities  of  development  of  such  an  abnormal 


GENERAL  THEORY  OF  NEUROSIS     13 

psychosexual  constitution  Freud  has  explained 
in  detail  in  his  "Drei  Abhandlungen  zur  Sexual- 
theorie."  Added  to  the  hereditary  and  constitu- 
tional prerequisite  conditions  of  the  neurosis, 
there  are  many  premature  sexual  experiences  and 
activities  which  act  as  agencies  favoring  its  out- 
break; the  importance  of  these  could  have  been  so 
long  overlooked  only  because  so  much  more  at- 
tention has  been  directed  to  that  long  past  period 
of  the  lifetimes  of  the  ancestors,  namely  heredity, 
than  to  that  long  past  period  in  the  history  of  the 
individual,  namely,  early  childhood.  Freud  has 
done  a  great  service  in  calling  attention  to  the 
early  seduction  of  children  by  other  children  or 
adults  and  the  abnormal  reaction  to  these  experi- 
ences as  a  result  of  an  especial  susceptibility  to 
these  impressions.  "The  greatest  effect  will  be 
produced  by  the  neurosis  when  constitution  and 
experience  combine  toward  the  same  end.^  An 
outspoken  constitution  may  be  able  to  escape  by 
the  impressions  of  life,  a  sufficient  shock  in  life 
may  bring  about  the  neurosis  in  an  average  con- 
stitution." ^     Besides  the  admitted  share  of  true 

eThe  admission  that  there  may  be  such  a  combination  of  dif- 
ferent causes  instead  of  the  assertion  of  one  set  of  causes  is  a 
peculiarity  of  the  Freudian  theory  of  the  neuroses  which  never 
fails  to  emphasize  the  variety  of  causes  and  in  no  way  conducts 
itself  in  a  one-sided  dogmatic  fashion  as  it  is  reproached  with 
doing. 

T  Lit.  No.  20. 


,    ! 


14      FREUD'S  THEORY  OF  THE  NEUROSES 

heredity,  Freud  has  revealed  a  pseudo-heredity  in 
the  influence  of  an  environment  of  nervous  peo- 
ple, namely  the  nervous  parents,  and  has  shown 
that  there  is  a  nearer  way  than  heredity  for  nerv- 
ous parents  to  transmit  their  disturbances  to  their 
childi-en.  "It  is  one  of  the  surest  signs  of  a  later 
neurosis  when  a  child  shows  itself  insatiable  in 
its  demands  for  caresses  from  the  parents  and,  on 
the  other  hand,  it  is  just  the  neuropathic  parents 
who  tend  to  exhibit  unbounded  affection  and  by 
their  fondling  predispose  the  disposition  of  the 
child  to  a  neurotic  outbreak  at  the  earliest  possible 
moment."  '^  Thus  upon  more  careful  analysis, 
what  appears  to  be  hereditary  transmission  re- 
solves itself  into  the  effect  of  powerful  infantile 
influences.  From  a  higher  point  of  view,  it  is 
observed  that  our  present-day  cultural  standard 
of  sexual  morality,  which  imposes  so  many  inju- 
ries and  restrictions  on  a  natural  life,  is  an  im- 
portant factor  in  the  causation  of  nervous  dis- 
eases, especially  the  true  neuroses.  Cultural, 
indeed  still  more  frequently,  material  agencies 
often  place  insurmountable  obstacles  in  the  way 
of  a  normal  sexual  life,  which  is  necessary  as  a 
protection  against  neurasthenic  and  anxiety- 
neurotic  troubles,  for  in  this  connection  it  is  found 
that  nothing  else  is  necessary  for  a  cure  except 
the  correction  of  the  inadequate  sexual  gratifica- 
tion.   Much  more  difficult  is  the  treatment  of  the 


GENERAL  THEORY  OF  NEUROSIS     15 

psychoneuroses ;  for  the  healing  of  these  a  very 
complicated  psychological  technique  has  been 
perfected,  which  will  be  explained  later;  in  cer- 
tain particulars  this  is  still  undergoing  deepen- 
ing and  refinement. 


rl:^^ 


CHAPTER  II 

THE  TRUE  NEUROSES 

A.  Neurasthenia:  Clinical  Picture;  Etiology;  Pro- 
phylaxis and  Therapy.  B,  Anxiety-Neurosis:  Symp- 
tomatology ;  Etiology ;  Theory.  C.  Refutation  of  the 
Objections  to  the  Sexual  Etiology  of  the  True  Neuroses. 

A.     True  Neurasthenia 

As  already  related,  while  Freud  was  following 
the  causative  sexual  injuries  in  detail,  he  suc- 
ceeded in  showing  that  neurasthenia  as  it  had  been 
described  by  the  earlier  authors  resolved  itself 
into  two  typical  clinical  pictures:  into  so-called 
"tyue  neur^i^ljl^gaigj'  and  into  anxiety-neurosis, 
which  forms  not  only  have  a  specific  etiology  but 
can  also  be  sharply  differentiated  clinically. 
Under  neurasthenia,  Freud  understands  those 
frequent  symptom-complexes  of  pressure  in  the 
head,  spinal  irritation,  dyspepsia  with  flatulency 
and  constipation,  paresthesias,  diminished  po- 
tency, as  well  as  a  prevailing  emotional  depres- 
sion. According  to  Freud's  views,  this  clinical 
picture  corresponds  to  the  specific  cause  of  exces- 
sive masturbation  or  frequent  pollutions  or  bet- 
ter expressed:  neurasthenia  may  in  every  case  be 

16 


THE  TRUE  NEUROSES  17 

traced  back  to  a  condition  of  the  nervous  system 
which  has  been  acquired  through  excessive  mas- 
turbation or  arisen  spontaneously  from  frequent 
^Dntmons.^  This  picture  of  neurasthenia  is  a 
fairly  uniform  one,  hence  the  various  pseudo- 
neurasthenias  (as  the  nervous  disturbances  of 
cachexia  and  arterio-sclerosis,  the  early  conditions 
of  progressive  paralysis  and  of  many  of  the 
the  psychoses,  etc.)  may  be  more  sharply  differ- 
entiated from  true  neurasthenia  than  formerly. 
Further,  according  to  Moebius's  proposal  many  a 
status  nervosi  of  hereditary  degenerates  can  be 
placed  at  one  side  and  one  will  also  find  reasons 
for  classifying  many  neuroses  which  are  to-day 
called  neurasthenia,  especially  those  of  intermit- 
tent or  periodical  nature,  more  properly  as  mel- 
ancholia (cyclothymia) .  The  neurasthenia  of  the 
authors  really  includes  much  more,  but  also  much 
that  is  ill-defined.  The  place  of  hypochondria 
remains  for  the  present  unexplained,  though  cer- 
tain forms  seem  to  correspond  to  a  third  form  of 
true  neurosis. 

To  make  easier  the  comprehension  of  true 
neurasthenia,  the  course  of  development  of  a 
typical  case  may  be  briefly  sketched.  A  boy 
who  practices  onanism  excessively^  at  puberty 

iLit.  No.  23. 

2  Light  forms  of  neurasthenia  because  of  corresponding  condi- 
tions may  be  found  in  childhood. 


18      FREUD'S  THEORY  OF  THE  NEUROSES 

usually  remains  without  control  until,  warned  by 
companions  or  one  of  those  dangerous  popular 
scientific  books,  he  is  changed  into  an  hypochon- 
driac who  interprets  the  symptoms  of  his  neuras- 
thenia as  the  premonitory  signs  of  a  softening  of 
the  brain  and  spinal  tuberculosis  resulting  from 
his  self-pollution.  Falling  into  anxiety  and  de- 
pression, he  suddenly  gives  up  his  masturbation 
and  often  begins  to  suffer  from  frequent  pollu- 
tions. The  outlet  provided  for  the  discharge  of 
the  sexual  product  by  the  act  of  masturbation 
does  not  correspond  to  the  complicated  spinal 
reflex  act  with  its  psychic  preliminaries  as  pro- 
vided by  normal  coitus.  From  this  abuse  arises 
also  the  widespread  symptom  of  ejaculatio 
prsecox,  which  betrays  years  afterward  the  youth 
who  had  been  greatly  given  to  onanism  with 
phantasies.^  Such  men  are  usually  not  in  con- 
dition to  give  the  woman  the  normal  outlet  for 
her  excitement  and  gratification  of  coitus,  a  con- 
dition which,  as  will  later  be  explained  in  detail, 
leads  to  anxiety-neurosis  in  the  woman.  It  is 
obvious  that  it  is  the  duty  of  the  physician  to  for- 
bid the  excessive  onanist  his  manner  of  sexual 
gratification.     But  it  is  recommended  that  this 

sThe  so-called  "mental  onanism"  (phantasies  leading  to  ejacu- 
lation), further  the  protracted  masturbation  which  puts  off  the 
ejaculation,  finally  the  "masturbatio  interrupta"  which  prevents 
the  ejaculation  seem  to  be  especially  injurious  (Stekel). 


THE  TRUE  NEUROSES  19 

be  done  without  dire  predictions  of  the  terrible 
results  of  continuing  this  vice,  in  contrast  to  the 
pseudo-scientific  articles ;  rather  it  should  be  done 
by  advising  a  gradual  giving  up  of  the  practice 
and  seeking  to  strengthen  the  patient  by  dietetic 
and  hydrotherapeutic  measures.  If  frequent  pol- 
lutions still  continue  then  a  strict  avoidance  of  all 
incentives  to  sexual  excitement  seems  indicated 
as  well  as  a  regulation  of  the  digestion.  If  the 
patient  is  not  helped  by  these  measures  then 
it  becomes  necessary  to  recommend  a  normal 
method  of  gratifying  the  sexual  appetite.  For 
the  sexual  need  once  aroused  and  long  gratified 
no  longer  permits  itself  to  be  silenced,  but  only 
transferred  to  another  object.  A  therapeutic 
interference  of  that  kind  is  also  best  suited  to  con- 
vince the  practical  physician  of  the  correctness  of 
the  specific  etiology  of  neurasthenia  here  de- 
scribed; for  a  cure  follows  the  removal  of  the  sex- 
ual injury.  That  the  former  therapeutic  meas- 
ures, such  as  sanitarium  treatment,  travel  and 
water  cures,  etc.,  now  and  then  show  results  is 
explainable  by  the  fact  that  unintentionally  they 
also  change  the  patient's  sexual  relations,  which, 
according  to  recent  investigations,  are  regularly 
the  cause  of  such  apparent  results.  These  im- 
provements are  therefore  often  only  transitory 
and  especially  unreliable. 

The  chief  service  which  the  wise  physician  can 


20      FREUD'S  THEORY  OF  THE  NEUROSES 

render  to  the  neurasthenic  lies  in  the  prophylaxis. 
If  excessive  masturbation  in  youth  is  the  cause  of 
neurasthenia,  then  the  prevention  of  the  same  in 
both  sexes  deserves  more  attention  than  it  has  yet 
received.  Until' now,  the  weighty  question  of 
masturbation  could,  however,  receive  no  decisive 
answer  because,  on  the  one  hand,  the  existence  of 
masturbation  in  the  suckling  and  child  has  not 
been  sufficiently  recognized  and,  on  the  other 
hand,  no  agreement  has  been  reached  between  the 
disparate  medical  views  regarding  the  onanism  of 
puberty  and  later  life.  The  purely  autoerotie 
masturbation  in  the  littlest  children  may  seldom 
and  only  in  excessive  cases  demand  the  interfer- 
ence of  the  tutor,  not  to  mention  the  physician. 
Childish  onanism  around  the  third  to  fourth  or 
fifth  years  must  within  certain  limits  be  consid- 
ered a  normal  phenomenon.^  Further,  this  is 
normally  soon  replaced  by  the  so-called  latent 
period.  If  this  does  not  occur  or  if  the  practice 
becomes  excessive,  then  it  must  be  checked. 
Nevertheless,  terrifying  and  gruff  prohibition  is 
to  be  avoided;  much  more  can  be  accomplished  by 
gentler  methods.  Often  in  the  neurosis  which 
breaks  out  later  there  appears  the  anxious  hal- 

4  Among  the  patients  suffering  from  impotence  are  a  relatively 
large  number  who  have  never  practiced  onanism  at  all,  and  there 
seems  to  exist  a  connection  between  the  neglect  of  the  act  of 
masturbation  which  presupposes  a  certain  activity  and  the  sexual 
weakness. 


THE  TRUE  NEUROSES  21 

lucination  of  parental  prohibitions;  through  the 
quite  customary  threat  of  cutting  off  the  penis,  a 
further  psychic  trauma  may  be  inflicted  which  is 
frequently  followed  by  lasting  and  pernicious 
results. 

Far  more  important  is  the  problem  of  the 
onanism  of  puberty  and  later  life,  over  which  the 
most  opposite  experiences  are  reported  and  the 
most  contradictory  views  held.  It  must  be  em- 
phasized at  the  beginning  that  this  onanism  can 
not  be  entirely  avoided,  because  in  our  civilized 
social  organization  too  great  an  interval  has  been 
interposed  between  the  awakening  of  the  sexual 
instinct  and  the  possibility  of  its  regular  gratifi- 
cation. There  is  thus  the  necessity  of  allowing 
this  mode  of  gratification  up  to  a  certain  degree, 
that  is  within  moderate  limits  and  with  quieting 
explanations;  it  can  then  be  observed  that  this 
happens  without  real  injury.  The  injuriousness 
of  a  precocious  or  later  excessive  onanism  is  only 
in  small  part  conditioned  by  the  very  nature  of 
masturbation.  There  is,  however,  a  special  sex- 
ual constitution  which  causes  certain  people  to 
become  ill  as  a  result  of  masturbation  while  others 
bear  their  onanism  of  puberty,  which  is  nothing 
more  than  the  revival  of  the  masturbation  of 
earliest  childhood,  without  noticeable  injury.  In 
general,  the  injuriousness  especially  of  excessive 
masturbation  is  not  to  be  doubted  in  the  least. 


22      FREUD'S  THEORY  OF  THE  NEUROSES 

even  if  a  part  of  the  medical  profession  is  not 
inclined  to  share  the  hypochondriacal  exaggera- 
tions of  many  nervous  patients  who  would  trace 
back  all  evil  to  their  self -gratification.  The  in- 
juriousness  begins  in  the  somatic  field  in  that 
onanism  gives  occasion  to  excessive  sexual  activ- 
ity, does  not  take  into  consideration  all  the  psy- 
chological sources  of  excitement,  affords  inade- 
quate relief  and  diminishes  potency.^  More  im- 
portant are  the  injuries  in  the  mental  field. 
These  come  to  light  both  in  the  demands  of  the 
sexual  life  and  also  in  those  of  the  social  life. 
For  the  former,  a  serious  result  is  a  lasting  inabil- 
ity to  endure  abstinence  or  coitus  interruptus. 
Further,  there  comes  about  a  sort  of  turning 
away  from  reality,  from  the  female  sexual  object, 
which  is  later  disclosed  in  an  intolerance  of  the 
necessary  imperfections  in  the  same.  As  one  of 
the  chief  mental  injuries  of  onanism,  must  finally 
be  asserted  the  fact  that  it  favors  in  every  relation 
the  fixation  of  an  infantile  condition  which  fur- 
nishes the  proper  foundation  for  the  psychoneu- 
rotic illness.  The  injuries  which  the  onanist  ex- 
periences for  his  social  life  are  numerous.  The 
easy  attainability  of  the  goal  of  gratification  in 
masturbation  weakens  the  individual — according 
to  the  Freudian  principle  of  psychosexual  par- 
's The  stomachache  of  onanists  should  also  be  mentioned.  (Com- 
pare Lit.  No.  34.) 


THE  TRUE  NEUROSES  23 

allelism,  that  is  the  typicalness  of  the  sexual  life 
for  his  behavior  in  other  relations  of  life — for 
the  strife  of  life  which  can  no  longer  be  under- 
taken with  the  necessary  display  of  energy. 
Through  his  turning  away  from  society,  the  t 
masturbator  becomes  antisocial  and  betrays  the 
result  of  his  vain  strife  against  passion  in  a  num- 
ber of  other  characteristics,  as  weak  will  power, 
doubt  of  the  possibility  of  accomplishment  and  | 
similar  self-reproaches.  Thus,  there  seems  to  be 
a  kind  of  mental  type  for  him  who  has  misused 
onanism.  From  these  considerations,  the  theory 
of  neurasthenia  should  undergo  a  revision. 

B.     The  Anxiety-Neurosis  ^ 

Especially  valuable  for  medicine  has  been 
Freud's  sharp  differentiation  of  the  symptom- 
complex  of  the  anxiety-neurosis  '^  from  the  pre- 
viously described  clinical  picture  of  true  neuras- 
thenia. The  name  anxiety-neurosis  arises  from 
the  fact  that  the  various  components  of  this 
symptom-complex  are  grouped  around  the  car- 

6^  Abbreviated  repetition  of  Freud's  work.  Lit.  No.  4.  Atten- 
tion should  here  be  called  to  the  fact  that  the  English  has  no 
exact  equivalent  for  the  German  word  "Angst"  which  connotes 
apprehension,  dread,  fear,  etc.,  in  addition  to  anxiety,  which  is 
the  nearest  English  word  and  the  one  which  will  be  used  through- 
out this  translation.    Trans. 

7  As  a  forerunner  of  the  Freudian  view  may  be  mentioned  the 
work  of  E.  Hecker,  *'tJber  larvierte  und  abortive  Angstzustande 
bei  Neurasthenic"  (Zentralblatt  fiir  Nervenheilkunde,  Dez.,  1893), 


24»   FREUD'S  THEORY  OF  THE  NEUROSES 

dinal  symptom  of  anxiety  to  which  each  indi- 
vidual symptom  shows  a  definite  relationship. 
..«^***^1'  Clinical  Symptomatology  of  Anxiety-Neu- 
i  rosis, — The  clinical  pictm^e  of  the  anxiety-neu- 

rosis comprises  the  following  symptoms: 

1.  General  irritability  and  irritation.  A  spe- 
cial point  of  value  is  the  expression  of  this 
heightened  irritability  through  an  hyperesthesia 
for  visual  impressions  but  especially  through  an 
hyperesthesia  for  sounds,  hypersensitiveness  to 
noises.  This  is  also  frequently  the  cause  of  sleep- 
lessness, of  which  more  than  one  form  belongs  to 
the  anxiety-neurosis. 

2.  ^AnxiousjexpectatiQn,  a  condition  which  can 
be  best  illustrated  by  example*  A  lady,  for  ex- 
ample, who  is  suffering  from  anxious  expecta- 
tion, thinks  of  pneumonia  every  time  her  hus- 
band, who  has  catarrh,  has  an  attack  of  coughing 
and  sees  in  her  mind  liis  funeral  passing  by.  If, 
on  her  way  home,  she  sees  two  persons  standing 
together  in  front  of  the  door,  she  cannot  help 
thinking  that  one  of  her  children  may  have  fallen 
out  of  the  window;  when  she  hears  the  bell  ring, 
some  one  is  bringing  bad  news,  etc.,  while  in  all 
these  cases,  there  is  no  especial  occasion  to 
strengthen  such  a  mere  possibihty.  For  one 
form  of  anxious  expectation,  that  in  respect  to 
the  person's  own  health,  one  cannot  avoid  the  old 
name,  hypochondria. 


THE  TRUE  NEUROSES  25 

A  further  expression  of  anxious  expectation 
is  the  frequent  tendency  to  anxiety  for  certainty 
found  in  persons  of  great  moral  scrupulousness, 
which  likewise  varies  from  the  normal  up  to  skep- 
ticism. 

The  anxious  expectation  is  the  nuclear  symp-- 

_tom  of^hg  nem-osigj  in  it  may  plainly  be  seen  a 
part  of  the  theory  of  the  same.  It  can  be  said  that 
there  is  here  a  quantity_of^  free-J[oatin^ 

'^(Sgst)  at  hand  which  in  the  expectation  rules 

"*tfie  choice  of  ideas  and  is  always  ready  to  attach 
itself  to  any  passing  idea. 

3.  The jiiixiQusnass  3yhic|Lis_coniLtaiitIy-present 
can,  however,  also  break  through^intq  conscious".  \ 

"neS^  sudduniyrwtfiou^^  by  the 

course  of  ideasTthus  causing  an  attack  of  anxiety. 

'^uclTan  anxiety  attack  may  consist  of  either  an 
anxious  feeling  without  any  associated  idea  or 
of  the  idea  of  imjDcnding  death,  of  a  stroke,  or 
threatening  insanity,  or  some  paresthesia  may  be 
mixed  with  the  anxious  feeling  (like  the  hyster-  ! 
ical  aura),  or  finally,  with  the  feeling  of  anxiety  : 
may  come  a  disturbance  of  one  or  more  of  the  | 
bodily    functions,    the    respiration,    circulation, 
vasomotor  innervation,  glandular  functions,  etc. 
Out  of  this  combination,  the  patient  emphasizes 
now  one,  now  another  factor,  he  complains  of  heart 
cramp,   dyspnea,   sweating,   ravenous   appetite, 
etc.,  and  in  his  representation  the  anxious  feeling 


26      FREUD'S  THEORY  OF  THE  NEUROSES 

frequently  becomes  obscured  or  becomes  really- 
unrecognizable  and  described  as  a  ''bad  feeling" 
of  indefinite  discomfort. 

4.  There  are  therefore  rudimentary  attacks  of 
anxiety  and  equivalents  of  the  anxiety  at- 
tack  of  which  Freud  has  prepared  the  follow- 
ing list: 

(a)  Disturbances  of  the  heart's  action,  palpita- 
-tion  with  brief  arrhythmia,  with  longer  attacks 
of  tachycardia  up  to  severe  conditions  of  cardiac 
weakness,  the  differentiation  of  which  from  or- 
ganic affections  of  the  heart  is  not  always  easy; 
pseudo-angina  pectoris,®  a  delicate  diagnostic 
field. 

(6)  Disturbances  of  respiration,  many  forms 
of  nervous  dyspnea,^  asthmatic  attacks,  etc. 
These  attacks,  however,  are  not  always  accom- 
panied by  recognizable  anxiety. 

(c)  Attacks  of  sweating,  often  nocturnal. 

{d)  Attacks  of  shaking  and  treix.bling,  which 
may  only  too  easily  be  taken  for  hysterical. 

{e)  Attacks  of  ravenous  appetite  often  ac- 
companied by  vertigo. 

(/)  Diarrhea  in  form  of  attacks. 

8  Compare  M.  Herz,  "Die  sexuelle  psychogene  Herzneurose 
(Phrenokardie),'*  Braumiiller,  Vienna  and  Leipzic,  1909. 

9  Compare  M.  Herz,  "uber  eine  Form  der  Falschen  Dyspnoe 
('Seufzerkrampf'),"  Wiener  Klin.  Wochenschrift,  1909,  No.  39. 
Both  articles  of  Herz  give  superfluous  new  names  to  partial 
phenomena  of  the  anxiety-neurosis. 


THE  TRUE  NEUROSES  27 

(g)  Attacks  of  locomotor  vertigo.^^ 
(h)  Attacks  of  so-called  congestions,  about 
everything  which  has  been  called  vasomotor  neu- 
rasthenia. Here  may  be  mentioned  the  vaso- 
motor edemas,  the  sudden  dying  of  a  finger,  an 
arm  or  foot  (angina  pectoris  vasomotoria) ." 

(i)  Attacks  of  parethesias  (these,  however, 
seldom  without  anxiety  or  a  similar  feeling  of 
discomfort).    " 

5.  Nothing  but  a  variety  of  anxiety  attack  are 
the  frequent  night  terrors  (pavor  nocturnus  of 
adults),  commonly  accompanied  by  anxiety, 
dyspnea,  sweating,^  ^  etc.  This  disturbance  oc- 
casions a  second  form  of  sleeplessness  in  the 
framework  of  the  anxiety-neurosis.  "  In  addi- 
tion, the  pavor  nocturnus  of  children  shows  a 
form  which  undoubtedly  belongs  to  anxiety- 
neurosis.  It  frequently  has  an  hysterical  touch 
which  makes  it  appear  as  something  special  and 
brings  it  into  closer  connection  with  the  anxiety- 
hysteria  which  will  be  discussed  later. 

6.  A  prominent  place  in  the  symptomatology 
of  the  anxiety-neurosis  is  occupied  by  vertigo 

10  The  vertigo  can  become  a  foundation  for  a  locomotor  phobia 
such  as  agoraphobia. 

11  Compare  Curschmann  (Mainz),  "tjber  Angina  pectoris  vasa- 
motoria,"  III.  Jahresversammlung  d.  Gesellsch.  Deutscher  Ner- 
venarzte,  Vienna,  1909. 

12  Concerning  the  characteristic  dreams,  compare  the  latter  part 
•of  chapter  on  hysteria. 


28      FREUD'S  THEORY  OF  THE  NEUROSES 

which,  in  its  lightest  forms,  is  better  designated 
as  giddiness,  in  its  severer  types  as  *'flitiUliii  liftL  ^ 
vertigo"  with  or  without  anxiety,  which  belongs 
to  the  severest  symptoms  of  the  neurosis.  This 
vertigo  never  leads  to  complete  loss  of  equilib- 
rium. On  the  other  hand,  it  seems  possible  for 
such  an  attack  of  vertigo  to  be  replaced  by  an 
attack  of  profound  weakness.^^  Other  fatigue 
conditions  of  the  anxiety-neurosis  appear  to  de- 
pend on  a  heart  collapse.  Dizziness  at  heights, 
on  mountains  and  precipices  likewise  frequently 
accompanies  anxiety-neurosis. 

7.  On  a  basis  of  aiehronic  anxiousness  (anxious 
expectation)  on  the^ne  hand",  and  a  tendency  to 
attacks  of  vertigo  on  the  other,  two  groups  of 
typical  phobias  develop,  the  first  in  regard  to 
general  physiological  menaces,  tjie  other  in  regard 
to  locomotion.  To  the  first  group  belong  the 
anxiety  over  snakes,  thunder,  darkness,  vermin 
and  the  like  as  well  as  the  typical  moral  over- 
scrupulousness.^^  Forms  of  skepticism;  here 
the  unattached  anxiety  is  plainly  applied  to  the 
strengthening  of  doubts  which  are  instinctively 
implanted  in  every  person. 

13  Occasionally  a  sudden  unexpected  feeling  of  fatigue  precedes 
it.  Stekel,  "Nervosa  Angstzustande  und  ihre  Behandlung." 
Urban  und  Schwa rzenberg,  Vienna  and  Berlin,  1908. 

14  An  intensive  sexual  feeling  of  guilt,  which  can  already  be 
cultivated  by  children,  always  depends  on  the  suppression  of  ex- 
cessive libido. 


THE  TRUE  NEUROSES  29 

The  other  group  embraces  agoraphobia  with 
all  its  varieties  collectively  characterized  by  its 
relation  to  locomotion.^^  A  preceding  attack 
of  anxiety  is  here  frequently  the  foundation  of 
the  phobia. 

8.  The  digestion  in  anxiety-neurosis  undergoes 
only  a  few  but  characteristic  distui^bances.  Sen- 
sations like  a  tendency  to  nausea  and  vomiting 
are  not  rare  and  the  symptom  of  ravenous  ap- 
petite either  alone  or  with  other  congestions  can 
give  something  of  a  rudimentary  attack  of  anx- 
iety; as  a  chronic  change,  analogous  to  the  anx- 
ious expectation,  is  found  a  tendency  to  diar- 
rhea which  has  given  occasion  for  the  strangest 
diagnostic  errors.  The  diarrhea  is  the  analogue 
of  the  frequent  micturition  of  the  anxiety-neu- 
rosis. 

9.  The  paresthesias  which  may  accompany  the 
vertigo  or  attack  of  anxiety  are  of  interest  be- 
cause of  the  fact  that  they  are  associated  in  a 
reguar  sequence  like  the  sensations  of  the  hyster- 
ical aura.  Nevertheless,  these  associated  feel- 
ings, in  contrast  to  the  hysterical,  are  atypical 
and  changeable.  A  large  number  of  so-called 
rheumatic  patients  really  suffer  from  anxiety- 
neurosis.^^     In  addition,  many  cases  of  anxiety- 

15  For  this,  the  complete  psychoneurotic  mechanism  is  necessary; 
(compare  later). 
*6  Compare    F.    Pineles,    "Zur    Klinik    und    Pathogenese    der 


30      FKEUD'S  THEORY  OF  THE  NEUROSES 

neurosis  show  a  tendency  to  hallucinations ;  these 
cannot  be  considered  hysterical. 

10.  Many  of  the  so-called  symptoms  which 
accompany  or  replace  the  anxiety-neurosis  ap- 
pear in  chronic  form.  This  applies  especially 
.to/the  diarrhea,  vertigo  and  the  paresthesias. 
/  II.  Occurrence  and  Etiology  of  the  Anociety- 
Neurosis, — As  already  explained,  the  morphol- 
ogy of  this  malady  is  the  corollary  of  a  typical 
etiologj^  which  makes  it  preferable  to  consider 
men  and  women  separately.  Anxiety-neurosis 
occurs  in  females  classified  according  to  their  age 
and  positions  in  life  in  the  following  cases: 

(a)  Anxiety  of  virgins  or  adolescents.  A 
number  of  indisputable  observations  have  shown 
that  a  first  experience  with  the  sexual  problem,  a 
rather  sudden  revelation  of  what  up  to  that  time 
had  been  veiled,  for  example  by  the  sight  of  the 
sexual  act  or  of  the  male  genitals,  by  a  lecture, 
printed  or  pictorial  representation,  can  cause  an 
anxiety-neurosis  in  a  maturing  girl  which  is 
combined  with  hysteria  in  an  almost  typical  man- 
ner; ^"^ 

(fc)  Anxiety  of  the  newly  married.  Young 
women  who  have  remained  anesthetic  during  the 

sogenannten   *Harnsaureschmerzen,' "    Wiener  Klin,    Wochenschr,, 
1909,  No.  21. 

17  According  to  the  present  status  of  the  theory,  this  is  more 
properly  classed  as  anxiety-hysteria   (Angsthysterie). 


\  THE  TRUE  NEUROSES  ^         31 

first  cohabitations  often  develop  an  anxiety  neu- 
rosis which  disappears  again  after  the  anesthesia 
has  given  way  to  a  normal  feeling.  Total  an- 
esthesia is  not  meant  here,  but  that  of  those 
women  who  are  excitable  up  to  a  certain  degree 
but  are  incompletely  gratified; 

(c)  As  anxiety  of  women  whose  husbands  ex- 
liibit  ejaculatio  pra^cox  or  ^very  diminished  po- 
tency. 

( d )  Anxiety  of  women  whose  husbands  practice 
coitus  interruptus  or  reservatus.  These  last  two 
cases  belong  together,  for  it  is  easily  proven  from 
the  analysis  of  a  great  number  of  cases  that  the 
occurrence  depends  on  whether  or  not  the  woman 
is  gratified  during  coitus.  In  the  latter  case,  the 
ground  is  prepared  for  the  outbreak  of  an  anx- 
iety-neurosis. On  the  other  hand,  if  the  hus- 
band can  gratify  the  woman  either  through  a 
better  performance  of  the  act  or  by  preventing 
ejaculation  at  the  beginning  of  the  act,  she  re- 
mains free  from  anxiety-neurosis.  The  congres- 
sus  resei'vatus  by  means  of  a  condom  exposes  the 
woman  to  no  injury  if  she  is  very  easily  excited 
or  the  man  very  potent ;  in  other  cases,  this  kind 
of  conception-preventing  intercourse  is  not  less 
injurious  than  the  other  forms ; 

(^)  As  anxiety  of  widows  and  intentional  ab- 
stainers, often  in  typical  combination  with  obses- 
sions; 


32      FREUD'S  THEORY  OF  THE  NEUROSES 

(/)  As  anxiety  in  the  climacteric,  during  the 
last  great  climax  of  the  sexual  appetite. 

Classes  c,  d,  e,  embrace  the  conditions  under 
which  the  anxiety-neurosis  begins  most  fre- 
quently in  the  female  sex  and  earliest,  independ- 
ent of  hereditary  disposition. 

For  the  conditions  of  the  anxiety-neurosis  in 
men,  Freud  has  formulated  the  following  groups 
analogous  to  those  found  in  women : 

(a)  Anxiety  of  intentional  abstainers,  fre- 
quently combined  with  symptoms  of  defense  (ob- 
sessions, hysteria). 

(&)  Anxiety  of  men  as  a  result  of  unsatisfied 
excitement  (during  the  engagement  period) ,  fur- 
ther of  persons  who  through  fear  of  the  results  of 
sexual  intercourse  content  themselves  with  fond- 
ling and  looking  at  the  woman.  This  group  of 
conditions  (which  is  also  transferable  unchanged 
to  the  other  sex) ,  engagement,  relations  with  sex- 
ual forbearance,  afford  the  purest  cases  of  the 
neurosis. 

(c)  Anxiety  of  men  who  practice  coitus  inter- 
ruptus,  therewith  delaying  the  ejaculation  until 
the  woman  is  gratified.  This  form  of  anxiety- 
neurosis  in  men  is  usually  mixed  with  neuras- 
thenia. 

{d)  Anxiety  of  men  in  the  senium.  There  are 
men  who  show^^  a  climacteric  like  that  of  women 

18  Compare  F.  Pineles,  I.  c. 


THE  TRUE  NEUROSES  S3 

and  at  the  time  of  their  diminishing  potency  and 
increasing  libido,  develop  anxiety-neurosis. 

For  both  sexes,  the  two  following  classes  ap- 
ply: 

(e)  Neurasthenics  as  a  result  of  masturbation 
fall  into  anxiety-neurosis  as  soon  as  they  forego 
their  method  of  sexual  gratification.  These  per- 
sons have  rendered  themselves  especially  unable 
to  stand  abstinence. 

It  is  here  important  for  the  understanding  of 
the  anxiety-neurosis  to  notice  that  a  very  serious 
case  of  this  condition  occurs  only  in  men  who  re- 
main potent  and  in  women  not  entirely  anesthetic. 

(/)  Anxiety-neurosis  arises  in  both  sexes  occa- 
sionally from  overwork,  exhausting  exertion,  for 
example,  night  watching,  nursing  the  sick  and 
after  severe  illness. ^^ 

In  addition  to  the  results  of  his  observations, 
Freud  has  sought  to  give  a  theoretical  interpreta- 
tion of  the  pathogenesis  of  anxiety-neurosis  in 
which  he  takes  into  account  the  observation  that 
many  cases  of  anxiety-neurosis  accompany  an 
appreciable  lessening  of  the  libido  or  psychic 
pleasure. 

In  the  points  adduced  thus  far  concerning  the 
anxiety-neurosis  there  are  sufficient  stopping 
points  from  which  to  gain  a  view  of  the  mechan- 
ic Compare  in  this  connection  the  remarks  on  the  sexual  mechan- 
ism in  distinction  from  sexual  etiology  (later  in  this  chapter). 


34      FREUD'S  THEORY  OF  THE  NEUROSES 

ism  of  this  neurosis.  One  gains  the  impression 
that  it  has  to  do  with  an  accumulation  of  excite- 
ment ;  that  the  anxiety  which  corresponds  to  this 
accumulated  excitement  as  psychic  anxiety  which 
finds  no  outlet  is  of  somatic  origin;  and  further 
that  the  accumulated  excitement  is  of  a  sexual 
nature.  These  hints  favor  the  expectation  that 
the  mechanism  of  the  anxiety-neurosis  is  to  be 
sought  in  the  diversion  of  the  somatic  sexual  ex- 
citement from  the  psychic  and  in  the  abnormal 
application  of  this  diverted  excitement  caused 
thereby.  This  idea  of  the  mechanism  of  the 
anxiety-neurosis  can  be  made  clearer  by  a  con- 
sideration of  the  normal  sexual  process,  at  first 
only  as  it  occurs  in  men.  The  normal  sexual  act 
may  be  sketched  as  follows :  First  there  is  an  ac- 
cumulation of  somatic  excitation;  this  increases 
to  a  point  where  it  occasions  a  psychic  irritation, 
creating  the  libido ;  finally  this  is  discharged  by  a 
complicated  spinal  reflex  act  which  must  also 
carry  off  the  psychic  excitement  simultaneously. 
Such  a  psychic  discharge  is  only  possible  by  the 
way  which  Freud  has  called  adequate  or  specific 
action.  The  etiology  of  true  neurasthenia  and 
anxiet^^-neurosis  finds  its  place  in  the  outline  of 
this  representation  of  the  sexual  process,  which 
in  essentials  is  also  applicable  to  the  woman. 
Neurasthenia  ensues  every  time  the  adequate  dis- 
charge is  rejpacedTSjHali  inadequate  on^ 


THE  TRUE  NEUROSES  35 

normal  coitus  under  favorable  conditions  is  re- 
placed by  masturbation  or  spontaneous  pollution ;  ' 
all  agencies,  however,  which  hinder  the  psychic 
utilization  of  the  somatic  excitement  conduce  tp^ 
anxiety -neurosis. 

The  previously  described  etiological  conditions 
of  anxiety-neurosis  disclose  the  common  charac- 
teristic of  accumulation  of  excitement.  Inten- 
tional abstinence  constitutes  the  first  etiological 
factor  for  the  man  in  that  it  prevents  the  specific 
action  which  should  follow  the  libido.  The  so- 
matic excitement  is  thus  accumulated  and  is  dis-  i 
charged  in  other  ways.  In  this  way,  abstinence 
leads  to  anxiety-neurosis.  Abstinence  is  also  the 
real  factor  in  the  second  etiological  group,  that  of 
frustrated  excitement.  The  third  class,  that  of 
coitus  with  precautions  (reservatus),  acts  injuri- 
,  ously  by  disturbing  the  psychic  preparation  for 
the  sexual  discharge  since  it  interposes  another 
diverting  psychic  task  before  allowing  the  com- 
pletion of  the  sexual  act.  Anxiety  in  the  senium 
(climacteric  of  men)  demands  another  explana- 
tion. There  is  here,  as  in  the  climacteric  of 
women,  such  an  increase  in  the  production  of 
somatic  excitement  that  the  mind  proves  rela- 
tively inefficient  tp.care  for  the  same. 

The  etiological  conditions  in  the  woman  may 
without  difficulty  be  viewed  from  the  same  stand- 
points.    In  addition,  the  disagreement  between 


36      FREUD'S  THEORY  OF  THE  NEUROSES 

the  somatic  and  the  psychic  in  the  course  of  the 
sexual  excitement  can  occur  earlier  in  the  woman 
and; is  more  difficult  to  remove  than  in  the  man. 

Thus,  the  iPjeudi^^yjgw  considers  the  symp- 
toms of  the 'anxiety-neurosis  as  substitutes  in  a 
way  for  the  omitted  specific  action  which  should 
follow  the  sexual  excitement.  As  a  further  cor- 
roboration of  this  view,  it  should  be  remembered 
that  also  in  normal  coitus  the  excitement  is  ac- 
companied by  acceleration  of  the  respiration,  pal- 
pitation, sweating,  congestion,  etc.  In  the  cor- 
responding attack  of  anxiety  of  our  neurosis, 
there  is  the  dyspnea,  palpitation,  etc.,  of  coitus 
isolated  and  exaggerated. 

In  those  exceptional  cases  which  do  not  arise 
from  specific  causes  but  from  other  banal  in- 
juries, such  as  nursing  the  sick,  overwork,  etc., 
the  sexual  etiology  is  indeed  absent  but  the  ill- 
ness is  established  on  the  foundation  of  a  sexual 
mechanism,  since  general  exhaustion  renders  the 
mind  unable  to  care  for  the  somatic  excitement 
which  continually  makes  demands  on  it. 

This  reference  to  the  exceptional  causes  of  the 
anxiety-nem'osis  is  always  overlooked  by  the 
critics  who,  in  opposition  to  Freud,  think  they 
have  found  anxiety-neuroses  without  sexual  in- 
jury. This  explanation  of  a  sexual  mechanism 
replacing  a  sexual  etiology  is,  however,  a  very 
important  one,  and  it  is  easy  to  make  the  same  one 


THE  TRUE  NEUROSES  87 

for  those  very  similar  cases  of  neurasthenia  not 
of  sexual  etiology,  for  example,  those  occurring 
with  arterio-sclerosis.  In  these  conditions,  the 
disease  may  also  arise  from  indirect  disturbances 
of  the  elaboration  of  sexual  products  like  the  pri- 
mary disturbances  of  other  organic  processes. 
By  the  substitution  of  a  sexual  mechanism  for 
the  sexual  accidents,  there  may  result  a  progress 
in  the  comprehension  of  the  true  neuroses  similar 
to  that  which  the  theory  of  the  psychoneuroses 
experienced  when  the  importance  of  the  sexual 
traumas  was  replaced  by  infantilism  of  sexu- 
ality. 

C.     Refutation  of  the  Objections  brought  against  the 
Sexual  Etiology  of  the  True  Neuroses 

As  already  mentioned,  the  formerly  much 
greater  field  of  the  neuroses  has  been  lessened  by 
the  diseases  of  the  blood-forming  glands.  Neu- 
rasthenia and  anxiety-neurosis  constitute  the 
transition  from  the  sexual  neuroses  to  such  ex- 
quisite toxic  diseases  of  the  nervous  system.  They 
are  caused  by  disturbances  of  sexual  processes  in 
the  organism  which  we  must  call  chemical.  Fur- 
ther, they  actually  show  a  great  similarity  to  the 
phenomena  of  intoxication  and  abstinence;  the 
similarity  to  Basedow's  and  Addison's  diseases 
is  obvious. 

Freud,  in  his  assertions  regarding  the  etiology 


38      FREUD'S  THEORY  OF  THE  NEUROSES 

of  the  true  neuroses,  knew  that  in  bringing  for- 
ward the  sexual  etiology  he  adduced  nothing  com- 
pletely new,  for  the  undercurrents  in  medical  lit- 
erature which  took  this  fact  into  account  have 
never  disappeared.  Indeed,  in  many  of  these 
undercurrents,  the  cure  of  "sexual  difficulties" 
and  ^'nervous  weakness"  has  been  united  in  a 
common  promise.  Further,  the  official  medicine 
of  the  schools  has  really  noticed  these  relations, 
although  it  has  acted  as  if  it  knew  nothing  of 
them.  It  may  easily  be  perceived  that  a  dim  per- 
ception of  the  predominating  importance  of  sex- 
ual agencies  in  the  production  of  nervousness  such 
as  Freud  has  recently  sought  to  establish  scientifi- 
cally has  never  been  absent  from  the  consciousness 
of  the  laity,  as  many  of  the  naive  but  funda- 
mentally correct  expressions  of  patients  concern- 
ing the  cause  of  their  troubles  indicate. 

The  chief  objection  to  Freud's  assertion  of  a 
sexual  etiology  of  the  anxiety-neurosis  concerns 
the  fact  that  abnormal  relations  of  the  sexual  life 
are  so  exceedingly  frequent  that  they  must  al- 
ways be  at  hand  whenever  sought.  Thus,  the  ex- 
istence of  these  in  cases  of  anxiety-neurosis  cited 
does  not  prove  that  the  etiology  of  the  neurosis 
lies  therein.  Further,  the  number  who  practice 
coitus  interruptus  and  the  like  must  be  incom- 
parably greater  than  the  number  afflicted  with 
anxiety-neurosis.    In  reply  to  this,  it  may  be  as- 


y 


THE  TRUE  NEUROSES  39 

serted  that  in  the  recognized  tremendous  fre- 
quency of  the  neuroses  and  of  anxiety-neurosis 
in  particular,  one  ought  not  to  expect  to  find  a 
rare  etiological  agent;  further,  that  a  postulate  of 
pathology  is  actually  fulfilled  in  this  case,  namely, 
that  in  the  investigation  of  etiology,  the  etiological 
agent  must  be  proved  more  frequent  than  its  re- 
sult, since  for  the  latter  other  conditions  (as  dis- 
position, total  of  specific  etiologies,  other  banal 
injuries)  may  be  required;  finally,  that  the  de- 
tailed analysis  of  suitable  cases  of  anxiety- 
neurosis  proves  the  significance  of  the  sexual 
agency  beyond  dispute. 

Perhaps  many  a  one  who  is  entirely  ready  to 
take  into  account  the  sexual  etiology  of  the  nerv- 
ous malady  will  still  repudiate  it  as  one-sided  be- 
cause he  is  not  requested  to  direct  his  attention 
also  to  the  other  agencies  commonly  mentioned 
by  the  authors.  It  is  far  from  Freud's  intention 
to  substitute  the  sexual  etiology  of  the  neuroses 
for  every  other,  hence  he  would  explain  that  the 
efficiency  of  these  remains.  Freud  means  rather 
that  in  addition  to  all  the  known  and  probably 
rightly  recognized  etiological  agencies  of  the 
authorities  are  added  the  sexual,  which  have  not 
been  sufficiently  appreciated.  It  should  not  be 
forgotten  that  the  etiological  problem  of  the 
neuroses  is  at  least  as  complicated  as  that  of  other 
diseases.    A  single  pathogenic  influence  is  almost 


40      FREUD'S  THEORY  OF  THE  NEUROSES 

never  sufficient;  for  most,  a  combination  of  eti- 
ological agencies  is  necessary,  which  aid  one  an- 
other and  which  cannot  be  brought  into  opposi- 
tion to  one  another.  The  sexual  agencies  in  the 
etiology  of  the  neuroses  deserve,  however,  accorff^ 
ingToTT^iTd^listiffiatie;  to  be  assigned  a  prom- 
inent place  in  the  etiological  series.  For..^ly 
these  will  be  found  missing  in  no  case,  these  alone 
IffPBBIF'to  produce  tne  neurosis  witnoui  otBei 
assistance,  so  that  tlie  other  agencies  seem  re- 
duced  to  the  role  of  predisposing  or  supj)lemen- 
tary  causes;  these  alone  enable  the  physician  to' 
recognize  certain  relations  between  the  variety 
and  multitude  of  clinical  pictm-es.  Heredity, 
which  is  so  strongly  emphasized  by  most  authors, 
is  undoubtedly  an  important  factor  where  it  is 
found;  it  permits  a  severe  case  of  illness  to  re- 
sult where  otherwise  only  a  very  mild  one  would 
have  ensued.  Heredity  alone  is  inaccessible  to 
the  physician's  efforts,  while  the  sexual  causes 
are  just  those  which  oflFer  him  a  good  opportunity 
for  his  therapeutic  activity.  The  agency  of  over- 
work, which  physicians  so  gladly  tell  their  pa- 
tients is  the  cause  of  their  neurosis,  is  subjected  to 
excessive  abuse.  The  physicians  will  have  to  ac- 
custom themselves  to  explaining  to  the  official 
who  has  * 'overtaxed"  himself  in  his  office  or  the 
housewife  whose  household  duties  have  been  "too 
hard"  that  they  are  not  sick  because  they  have 


THE  TRUE  NEUROSES  41 

sought  to  perform  duties  really  easy  for  a  civilized 
brain  but  because  they  have  in  the  meantime 
grossly  neglected  and  stifled  their  sexual  life. 
Whoever  approaches  the  cases  from  ttiis  side  wiU 
find  the  proof  of  how  valuable  for  the  anamnesis 
are  these  points  of  view.  Naturally,  he  who 
would  convince  himself  from  his  patients  whether 
or  not  their  neuroses  are  really  connected  with 
their  sexual  life,  cannot  avoid  making  express  in- 
quiries regarding  their  sexual  life  and  giving  a 
truthful  explanation  of  the  same  without  being 
diverted  from  this  medical  duty  by  ethically  col- 
ored arguments.  It  would  facilitate  his  task  if 
the  patients  might  know  with  what  certainty  the 
trained  physician  can  now  detect  the  meaning  of 
their  neurotic  difficulties  and  the  inference  from 
these  to  the  real  sexual  etiology.  The  semblance 
of  negative  cases  without  sexual  etiology,  which 
might  be  given  by  a  negative  result  of  the  exam- 
ination, is  explained  by  the  fact  that  behind  such 
cases  is  an  hysteria  (anxiety-hysteria)  or  obses- 
sional neurosis  which  the  actual  neurosis  merely 
imitates.  Such  hysterias  in  the  form  of  neuras- 
thenia are  not  at  all  rare ;  a  more  penetrating  in- 
vestigation by  means  of  psycho-analysis  invari- 
ably unmasks  them.  For  the  very  frequent  mixed 
forms  of  true  and  psycho-neuroses,  it  is  recom- 
mended in  many  cases  to  overlook  at  first  the 
psycho-neurotic  component  in  the  clinical  picture 


^ 


42      FREUD'S  THEORY  OF  THE  NEUROSES 

and  to  combat  therapeutically  the  true  neurosis ; 
in  this  way  one  can  sometimes  succeed  in  becom- 
ing master  also  of  the  separated  psychoneurosis. 
The  anxiety-neurosis  is  such  a  widespread 
malady  that  it  is  daily  encountered  in  practice. 
Its  prevention  would  be  a  weighty  social  task; 
still,  the  elimination  of  certain  injuries  is  depen- 
dent on  so  many  material  and  social  factors  that 
an  ideal  accomplishment  of  the  task  under  pres- 
ent civilized  conditions  is  not  to  be  thought  of. 
This  much  can  be  said,  that  only  an  individual 
who  has  no  great  sexual  appetite  can  endure  ab- 
stinence and  that  the  entire  abstinence  before 
marriage  is  not  to  be  generally  recommended,  let 
alone  demanded,  since  it  can  lead  in  many  cases 
to  deficient  capacity  for  work  and  indeed  directly 
to  a  neurosis.  Still,  complete  abstinence  is  re- 
peatedly harmless  just  as  frustrated  excitement 
or  methods  of  imperfect  gratification  are.  Fi- 
nally, if  it  is  necessary  for  a  married  couple  to 
go  without  children,  harmless  measures  for  the 
prevention  of  conception  must  be  employed  which 
are  suited  to  the  tolerance  of  the  individuals  par- 
ticipating. That  from  this  standpoint  of  liberal 
legislation  in  relation  to  the  introduction  of  arti- 
ficial abortion  may  be  favored  is  conceivable.^^ 
Thus,  here  again,  just  as  in  the  prophylaxis  of 

20  Compare  Wittels,  "Die  sexuelle  Not."    C.  W.  Stern,  Vienna 
and  Leipzic,  1909. 


THE  TRUE  NEUROSES  43 

neurasthenia,  it  is  shown  that  these  neuroses  are 
rooted  in  a  true  sense  in  our  whole  present-day 
sexual  morality  and  that  only  a  thorough  change 
of  our  entire  social  and  economic  organization  can 
bring  humanity  the  solution  of  the  old  inherited 
evil  of  nervousness. 


11 


CHAPTER  III 

THE  SEXUAL  INSTINCT 

Existence  and  Significance  of  Sexuality  in  Children; 
Opposition  to  the  Acceptance  of  This  Discovery.  The 
Sexual  Theory:  A.  Infantile  Sexuality:  1,  Sexual- 
ity of  the  Suckling.  2.  Sexuality  in  Children.  3. 
Changes  at  Puberty.  B»  The  Deviations  of  the  Sexual 
Instinct:  Inversion,  Perversion,  Fetichism,  Sadism, 
Masochism,  Exhibitionism,  etc.  C.  Sexuality  of  Neu- 
rotics. Confirmation  of  the  Theory  by  Analysis  of 
Neuroses  of  Children.  Infantile  "Sexual  Theories." 
Nuclear-Complex  of  the  Neuroses. 

Freud  has  discovered  by  way  of  psycho-an- 
alysis the  existence  of  a  sexual  life  in  children  and 
has  described  the  phenomena  in  detail  in  his 
classic,  "Drei  Abhandlungen  zur  Sexualtheorie." 
The  entirely  new  conception  that  the  pure,  in- 
nocent child  could  have  a  sexual  life  met  much 
opposition.  Besides  this  sentimental  opposition, 
there  is  the  infantile  amnesia  which  veils  ^  the  first 

1  This  amnesia  for  the  first  years  of  childhood  is  not  a  complete 
one  but  is  broken  through  by  entirely  isolated  childhood  memories 
of  indifferent  and  secondary  content  behind  which,  however,  is 
hidden  a  weighty  and  important  content  which  may  be  shown  by 
psycho-analysis.    Freud   has   called   these   "cover-memories"   be- 

44 


THE  SEXUAL  INSTINCT  45 

years  of  childhood  for  most  people  up  to  the  sixth 
or  eighth  year  and  hinders  their  acknowledging 
the  fact  of  infantile  sexuality.  And  still  we  know 
that  our  memory  can  be  fully  reviewed  and  repro- 
duced at  no  time  of  life;  on  the  other  hand, 
psycho-analysis  has  shown  that  the  very  impres- 
sions which  we  have  forgotten  leave  behind  the 
deepest  traces  in  our  mental  life  and  have  become 
determining  for  our  whole  later  development. 
Thus,  there  can  be  no  real  forgetting  of  child- 
hood impressions,  but  only  an  amnesia  like  that 
which  we  observe  in  neurotics  for  their  later  ex- 
periences, the  essential  feature  of  which  is  a  mere 
detention  of  consciousness  (repression) .  This  is 
the  first  amnesia  which  appears  in  the  life  of  an 
individual  and  it  seems  probable  that  no  hyster- 
ical amnesia  would  be  possible  without  this  in- 
fantile amnesia. 

It  is  the  same  with  the  observations  of  sexual 
expressions  in  childhood  as  with  many  other  ob- 
servations, they  only  really  impress  one  when  they 
are  examined  and  described  collectively.  The 
physicians  who  have  once  directed  their  attention 
to  this  side  of  the  child's  mental  life  will  find^  in 

cause  they  serve  as  substitutes  for  the  really  important  impres- 
sions, the  direct  reproduction  of  which  meets  a  resistance. 
(Compare  Lit.  No.  13.) 

a  Compare  for  example  Bleuler's  work  on  "Sexuelle  Abnor- 
mitaten  der  Kinder"  (Jahrbueh  d,  9chw$iz.  Oei  f.  Sehulgetund- 
heitap/leffe,  IX,  1908). 


46   FREUD'S  THEORY  OF  THE  NEUROSES 

every  case  traces  of  a  sexual  instinct  early  ex- 
pressing itself;  hence  Freud  can  assert  without 
injustice  that  the  time  will  soon  come  when  one 
will  publish  as  rare  exceptions  cases  which  in  no 
way  betray  expressions  of  sexuality  in  the  first 
years  of  life. 

A.     The  Infantile  Sexuality 

1.  Sexuality  in  the  Suckling. — Freud  has  em- 
phasized the  fact  that  the  child  brings  with  it  into 
the  world  the  germ  of  sexuality  and  enjoys  in  the 
takings  of  nourishment  sexual  pleasure  which  it 
ever  after  seeks  to  procure  by  sucking,  indepen- 
dent of  the  taking  of  food.  The  Hungarian 
pediatrist,  Dr.  Lindner,  has  devoted  a  penetrat- 
ing study  to  the  sucking  or  pleasure-sucking  of 
children.^  The  sucking  which  appears  in  the 
suckling  and  if  it  becomes  fixed  as  a  childish  fault 
can  be  continued  even  up  to  the  years  of  maturity, 
consists  in  a  rhythmically  repeated  sucking  move- 
ment with  the  mouth  (lips)  in  which  the  object 
of  taking  nourishment  is  excluded.  One  part  of 
the  lips  or  any  other  skin  surface  which  can  be 
reached,  perhaps  the  big  toe,  is  taken  as  the  ob- 
ject on  which  the  sucking  is  carried  out.  There- 
with appears  a  complete  absorption  of  the  atten- 
tion and  the  "pleasure-sucking"  ends  in  falling 

^Jahrbuch  fur  Kinderheilkunde,  N.  F.,  XIV,  1879. 


THE  SEXUAL  INSTINCT  47 

asleep  or  even  in  a  kind  of  orgasm.^  Often,  there 
is  combined  with  the  pleasure-sucking  a  rubbing 
of  certain  sensitive  parts  of  the  body,  the  breast, 
the  external  genitals,  etc.  In  this  way,  many 
children  proceed  from  sucking  to  masturbation. 
There  is  no  doubt  that  we  are  here  dealing  with  a 
sexual  condition  which  presents,  however,  many 
difficulties  to  its  comprehension,  since  the  instinct 
is  not  directed  toward  other  persons  biit  is  grati- 
fied on  the  child's  own  body  in  a  manner  called  by 
H.  Ellis,  "autoerotic."  In  this  connection,  the 
mouth  and  lips  are  revealed  as  erogenous  zones,  a 
significance  which  they  retain  in  later  normal  life 
in  the  kiss.  For  many,  it  may  occasion  surprise 
to  learn  that  sucking  is  exhibited  independently 
of  its  relation  to  the  hunger  instinct.  It  is,  how- 
ever, plain  that  the  mouth  zone  is  at  first  con- 
cerned only  with  the  gratifying  of  the  hunger  in- 
stinct ;  later,  the  desire  for  a  repetition  of  pleasur- 
able experiences  gained  in  this  way  is  separated 
from  the  need  of  taking  nourishment,  thereby 
transforming  this  mucous  surface  into  an  erogen- 
ous zone.  It  is  to  be  assumed  that  even  those 
children  who  later  remain  normal  had  the  childish 
fault  of  sucking  in  whom  the  erogenous  impor- 

*Here  is  already  shown  something  which  is  applicable  to  the 
whole  of  life,  namely,  that  sexual  gratification  is  the  best  hypnotic. 
Most  cases  of  nervous  insomnia  go  back  to  lack  of  sexual 
gratification. 


48      FREUD'S  THEORY  OF  THE  NEUROSES 

tance  of  the  lip  zone  was  constitutionally- 
strengthened.  If  this  accentuation  persists,  these 
children  as  adults  become  passionately  fond  of 
kissing,  tend  to  perverse  kissing  or  if  men  show  a 
strong  tendency  to  smoking  and  drinking.  If 
the  repression  intervenes,  however,  then  there  is 
produced  an  aversion  for  eating  and  hysterical 
vomiting.  Because  of  these  diiBf erent  functions  of 
the  lip-zone,  the  repression  is  carried  over  to  the 
hunger  instinct.  All  later  hystericals  with  dis- 
turbances of  eating,  globus,  snoring  in  the  throat 
and  vomiting  have  during  childhood  been  ener- 
getic suckers. 

Both  the  essential  characteristics  of  infantile 
sexual  expression  which  the  sucking  displays, 
namely,  autoeroticism  and  the  domination  of  the 
erogenous  zones,  exhibit  also  the  other  activities 
of  the  infantile  sexual  instinct.  Thus,  in  par- 
ticular, the  masturbation  of  the  suckling  which 
scarcely  an  individual  escapes  and  which  is  plainly 
appointed  to  fix  the  future  primacy  of  the  genital 
zone  for  the  later  sexual  functions.  The  action 
which  allays  the  irritation  and  furnishes  the  grati- 
fication consists  of  a  rubbing  friction  with  the 
hand  or  a  pressure  of  the  tightly  approximated 
thighs. 

To  one  who  is  little  acquainted  with  neurotics 
and  who  has  not  encountered  these  phenomena 
in  adult  patients  in  their  full  importance,  Freud's 


THE  SEXUAL  INSTINCT  49 

disclosure  that  the  anal  zone  of  the  child  may  af- 
ford pleasurable  sensations  seems  at  first  hardly 
conceivable.^  Nevertheless,  one  can  occasionally 
observe  in  little  children  that  they  refuse  to  empty 
the  bowels  when  they  are  placed  on  the  closet 
because  they  obtain  pleasure  from  defecation 
when  the  retained  stool  by  its  accumulation  excites 
strong  musclar  contractions  and  in  the  passage 
through  the  anus  produces  a  strong  irritation  of 
the  mucosa.  Therewith,  the  pleasurable  sensa- 
tion must  be  reahzed  besides  the  painful  one. 
The  frequent  intestinal  catarrhs  of  childhood  af- 
ford occasion  for  intense  excitement  of  these 
erogenous  zones.  Intestinal  catarrh  in  the 
youngest  years  makes  the  patients  "nervous"  as 
it  is  called.  In  later  neurotic  maladies,  these  ex- 
ert a  determining  influence  on  the  symptomatol- 
ogy of  the  neurosis,  placing  at  its  disposal  the 
whole  range  of  intestinal  disturbances.  Thus, 
the  original  masturbationary  irritation  of  the  anal 
zone  which  is  often  practiced  by  older  children 
and  adult  neurotics  with  the  aid  of  the  fingers  is 
one  of  the  roots  of  the  constipation  so  frequently 
found  in  neuropaths.  The  great  importance  of 
the  anal  zone  is  reflected  in  the  fact  that  one  finds 
only  few  neurotics  who  have  not  their  special 
skatalogical  customs,  ceremonials,  etc.     It  is  just 

5  Remains   of   continued   "analeroticism"   are   often   found   in 
adults. 


50      FREUD'S  THEORY  OF  THE  NEUROSES 

these  coprophiliacs,  that  is,  those  who  associated 
pleasurable  emotions  with  the  excrements  in 
childhood,  who  are  most  profoundly  perplexed 
by  the  repression;  Freud  has  shown  the  impor- 
tant part  which  these  instinctive  impulses  des- 
tined to  be  suppressed  play  in  the  later  character 
formation.  Psycho-analysis  of  neurotics  re- 
vealed the  fact,  purely  empiric,  that  individuals 
who  have  successfully  repressed  an  anal  eroti- 
cism, which  was  originally  intense,  regularly  show 
certain  traits  of  character  in  unmistakable  form : 
orderliness,  frugality,  and  stubbornness.^ 

Also  entirely  new  is  the  Freudian  discovery 
that  the  neck  of  the  bladder  can  serve  as  an  erog- 
enous zone.  Pollution  in  the  child  lacking  a  sex- 
ual secretion  seems  to  take  the  form  of  an  excre- 
tion of  urine  and  may  lie  at  the  bottom  of  many 
cases  of  eneuresis.  Further,  in  later  life,  especi- 
ally in  neurotics  there  occurs  simultaneously  with 
the  sexual  excitement  a  desire  to  micturate  and 
urination  very  frequently  appears  in  dreams  as 
the  symbol  of  the  sexual  act."^  The  bed- wetting 
which  plays  a  great  role  in  the  previous  histories 
of  neurotics  is  repeatedly  closely  connected  with 
masturbation. 

The  sources  of  all  these  sexual  excitements  lie 

•  For  the  attempt  at  a  psychological  explanation  of  the  con- 
nection, compare  Freud,  "Charakter  und  Analerotik,"  Lit.  No.  29. 
7  The  biological  problems  connected  with  the  theory  of  the  ero- 


THE  SEXUAL  INSTINCT  51 

in  part  in  internal  processes,  in  part  are  brought 
about  through  peripheral  irritation  of  these  zones 
(anal,  genital)  by  the  cleansing  as  well  as  by  ca- 
ressing of  parents  and  nurses. 

These  germs  of  sexual  excitement  in  the  new 
born  develop  for  a  time,  then  undergo  a  progres- 
sive suppression  in  a  "latent  period"  which  is 
normally  interrupted  about  the  third  or  fourth 
year.  During  this  period  of  complete  or  merely 
partial  latency,  as  a  result  of  organic  processes 
(organic  repression)^  and  the  indispensable  help 
of  the  education,  the  mental  forces  are  formed 
which  appear  later  as  inhibitions  to  the  sexual  in- 
stinct and  narrow  its  course  like  dams:  the  dis- 
gust, the  feeling  of  shame,  the  esthetic  and  moral 
standards  of  ideas.  During  the  latent  period, 
another  part  of  these  sexual  energies  is  separated 
from  the  sexual  aim  and  applied  to  cultural  and 
social  ends,  a  process  which  Freud  has  designated 
by  the  name  sublimation  as  important  for  cul- 
ture, history  and  the  individual.  The  possibil- 
ity of  certain  components  of  the  sexual  instinct 
being  diverted  from  the  original  goal  to  a  higher 

genous  zones  are  treated  in  a  valuable  "Studie  iiber  Minderwertig- 
keit  von  Orgaren,"  by  Dr.  Alf.  Adler  (Urban  &  Schwarzenberg, 
Vienna  and  Berlin,  1907). 

8  The  nature  of  this  process  which  corresponds  in  a  way  to  an 
organic  developmental  tendency  is  still  unexplained;  its  importance 
for  the  origin  of  the  psychoneuroses  is  pointed  out  in  the  chapter 
on  hysteria. 


54      FREUD'S  THEORY  OF  THE  NEUROSES 

and  no  longer  sexual  aim  furnishes  in  later  life 
additional  energies  to  our  mental  powers;  to 
these,  we  probably  owe  our  highest  cultural  at- 
tainments. 

From  this  point  of  view,  the  often  expressed 
skepticism  regarding  the  specific  virulence  of  the 
sexual  etiology  loses  its  justification.  No  in- 
stinct so  important  and  necessary  for  the  further- 
ance of  culture  is  limited  and  suppressed  like  the 
sexual  instinct,  from  childhood  on,  chiefly  in  its 
perverse  manifestations.  The  afflictions  known 
as  neuroses  are  to  be  traced  back  to  the  manifold 
forms  of  misfortune  which  may  befall  this  trans- 
formation process  of  the  components  of  the  sex- 
ual instinct. 

2.  Sexuality  in  Children. — The  sexuality  of  the 
suckling  returns  in  the  years  of  childhood,  al- 
though a  fixed  time  for  this  cannot  be  named. 
This  reappearance  of  sexual  activity  is  deter- 
mined by  internal  causes  and  external  conditions. 
At  the  head,  stands  the  influence  of  seduction, 
which  treats  the  child  prematurely  as  sexual  ob- 
ject. Recent  investigations  have  shown  that  the 
child  now  and  then  very  prematurely,  at  the  age 
of  three  to  five  years,  is  capable  of  a  choice  of  an 
object  accompanied  by  effects  and  not  merely  of 
a  series  of  autoerotic  gratifications.  This  pre- 
mature sexual  appetite  is  directed  at  first  toward 
the  parents  and  nurses,  a  choice  of  object  which 


THE  SEXUAL  INSTINCT  53 

springs  from  the  dependency  of  the  child.  One 
can  also  observe  without  trouble  that  the  appar- 
ently most  harmless  love  affairs  of  little  children 
are  not  without  an  erotic  tinge.^ 

It  is  obvious  that  seduction  is  not  necessary  to 
awaken  the  sexual  life  of  the  child  in  this  second 
period  and  that  such  awakening  can  also  occur 
spontaneously  from  internal  causes.  It  is  now 
instructive  to  observe  that  the  child  under  the  in- 
fluence of  occasional  seduction  can  become  poly- 
morphous-perverse, that  is  to  say,  can  be  seduced 
to  all  possible  transgressions;  this  shows  that  it 
brings  along  within  its  own  person  the  possibility 
for  this  condition.  It  brings  with  it  the  tendency 
to  all  perversions  and  as  a  result  of  its  bisexual  na- 
ture also  the  tendency  toward  inversion  (homo- 
sexuality) ;  its  development  either  into  a  neurosis 
or  normality  is  conditioned  on  the  special  em- 
phasis of  certain  instincts  and  zones  as  well  as  on 
the  experiences  of  childhood.  All  the  peculiar- 
ities of  this  second  infantile  sexual  activity  lie 
behind  the  deepest  impressions  in  the  (uncon- 
scious) memory  of  the  individuals  and  condition 
the  development  of  their  characters  if  they  remain 
healthy,  of  the  symptomatology  of  their  neuroses 
if  they  become  afflicted  with  one  after  puberty. 

»  Compare  the  interesting  work  of  Sanf ord  Bell,  "A  preliminary 
study  of  the  emotion  of  love  between  the  sexes"  {Amer,  Jour, 
Psych.,  1902f). 


54      FREUD'S  THEORY  pF  JHE  NEUROSES 

In  the  latter  case,  one  finds  this  sexual  period  for- 
gotten and  the  conscious  memories  formed  of  it 
displaced.  Freud,  however,  also  brings  the  nor- 
mal infantile  amnesia  into  connection  with  this 
infantile  sexual  activity.  Through  psycho-ana- 
lytic investigation,  it  has  been  possible  to  render 
this  forgotten  material  conscious  and  thereby 
overcome  an  obsession  which  came  from  the  un- 
conscious psychic  material. 

The  perversions  contained  in  the  polymor- 
phous-perverse tendencies  may  be  traced  back  to 
a  series  of  partial  or  component  instincts  which  in 
themselves,  however,  are  not  primary.  Besides 
an  instinct  not  itself  sexual  arising  from  motor 
impulse  sources,  one  distinguishes  in  these  a  con- 
tribution from  an  irritation  of  the  receptive  organ 
(skin,  mucosa,  sense  organ)  of  the  erogenous 
zones,  the  excitation  of  which  lends  to  the  instinct 
the  sexual  character;  as  such  partial  or  component 
instincts,  Freud  has  revealed  exhibitionism,  the 
peeping  tendency,  active  and  passive  algolagnia 
( sadism  and  masochism )  and  others.  The  undis- 
guised pleasure  of  the  little  child  in  the  undress- 
ing of  its  body  and  in  particular  of  its  genital 
parts  shows  the  exhibitionistic  tendency.  The 
coimterpart  of  this  in  later  life  as  a  perverse  ten- 
dency is  the  curiosity  to  see  the  genitals  of  other 
persons  (Schaulust,  peeping  tendency)  which  un- 
der suitable  influence  can  attain  a  great  im- 


THE  SEXUAL  INSTINCT  55 

portance  for  the  sexual  life  of  the  child.  Look- 
ing at  and  handling  the  genitals  of  playmates  is 
not  rare  and  such  children  become  voyeurs  (peep- 
ers), ardent  observers  of  the  micturition  and 
defecation  of  others.  The  roots  of  sadism  are 
easily  detected  in  normal  individuals  in  the  ag- 
gression which  the  sexuality  of  most  male  indi- 
viduals exhibits,  the  biological  importance  of 
which  may  lie  in  the  necessity  of  overcoming  the 
resistance  of  the  sexual  object  otherwise  than  by 
the  act  of  courtship.  Thus,  sadism  corresponds 
to  an  aggressive  component  of  the  sexual  instinct 
which  has  become  independent  and  exaggerated 
through  having  been  moved  by  displacement  to  a 
preponderating  influence.  Nevertheless,  the 
complete  psychological  analysis  of  the  sadistic 
instinct  has  not  yet  succeeded.  Also  for  masoch- 
ism, a  normal  root  cannot  be  denied  in  the  sexual 
overvaluation  (compare  later).  As  a  further 
root  of  masochism,  the  painful  irritation  of  the 
skin  of  the  buttocks  in  spanking  is  to  be  empha- 
sized. 

The  study  of  the  component  instincts  revealed 
the  important  discovery  that  the  sexual  instinct 
itself  is  not  a  unit  but  a  composite  structure  of 
many  components  which  are  again  set  free  in  the 
perversions. 

For  the  origin  of  sexual  excitation  in  this  sec- 
ond period  of  sexuality  in  childhood,  we  go  back 


56      FREUD^S  THEORY  OF  THE  NEUROSES 

to  the  following:  (a)  To  an  imitation  of  a  grati- 
fication experienced  in  connection  with  other  or- 
ganic processes  (for  example,  sucking) ;  (&)  to 
suitable  peripheral  irritation  of  erogenous  zones ; 
(c)  to  the  expression  of  some  instinct,  the  origin 
of  which  is  not  entirely  plain  to  us  as  yet,  as  the 
peeping  tendency  (Schautrieb)  and  the  tendency 
to  cruelty. 

Rhythmical  mechanical  movements  of  the  body 
likewise    cause    pleasurable    sensations;    hence, 
swinging,  being  tossed,  rocking,  as  well  as  rail- 
road and  carriage  journeys  are  so  much  liked  by 
children.^^     That  the  muscular  activity  set  up  by 
scuflEling  and  wrestling  with  playmates  can  serve 
as  a  sexual  excitation  is  also  recognized.     Fear 
and  anxiety  can  likewise  call  forth  sexual  excita- 
tion, in  connection  with  which  the  feelings  of  ir- 
ritation caused  by  anxiety  in  school  children  which 
can  then  lead  to  onanism  and  pollution  may  be 
particularly  mentioned.     Finally,  it  is  undeniable 
1  that  the  concentration  of  the  attention  on  an  in- 
Itellectual  task  in  young  or  mature  persons  may 
(result  in  a  coincident  sexual  excitation;  this  is 
! probably  the  only  just  ground  for  attributing 

10  Freud  thinks  that  we  may  assume  that  these  influences  which 
in  mild  intensity  are  sources  of  sexual  excitement  may  have,  when 
connected  by  fright  with  violent  mechanical  shaking,  an  etiological 
significance  for  hysteriform  traumatic  neurosis.  He  has,  how- 
ever, not  yet  taken  traumatic  hysteria  into  the  scope  of  his  in- 
vestigation. 


THE  SEXUAL  INSTINCT  57 

nervous  disturbances  to  intellectual  overwork,  a 
cause  formerly  assigned  but  always  doubtful. 

3.  The  Changes  at  Pubertuc^— The  latent  pe- 
riod lasts,  apart  from  the  mterruptions  men- 
tioned, up  to  the  changes  at  puberty  in  which  the 
heretofore  autoerotic  character  of  the  sexual  ac- 
tivity is  lost  and  the  instinct  finds  its  object.  Un- 
til now,  this  was  composed  of  separate  instincts 
and  derived  from  erogenous  zones  which  sought 
independently  of  one  another  a  certain  pleasure 
as  the  only  sexual  goal.  The  new  sexual  aim 
which  is  created  by  the  changes  of  puberty  and  is 
characterized  by  an  amalgamation  of  all  instinc- 
tive tendencies  which  proceed  from  the  erogenous 
zones  consists  in  the  man  in  the  discharge  of  the 
sexual  product;  for  the  accomplishment  of  this, 
there  must  be  a  subordination  of  all  the  erogenous 
zones  to  the  primacy  of  the  genital  zone,  which 
is  facilitated  by  the  development  of  the  genital 
organs  and  the  elaboration  of  the  seminal  secre- 
tion. To  the  conditions  which  first  appear  at 
puberty,  there  is  also  added  that  "pleasure  of 
gratification"  (Befriedigungslust)  of  sexuality 
which  ends  the  normal  sexual  act:  the  end- 
pleasure  (Endlust).  The  pleasure  derived  pre- 
viously from  the  excitation  of  the  erogenous  zones 
needs  a  name  for  itself  and  is  called  in  contrast 
by  Freud,  the  fore-pleasure   (Vorlust).^^     The 

11  Later  material  on  the  mechanism  of  the  f ore-pleasure  as  well 


58      FREUD'S  THEORY  OF  THE  NEUROSES 

finding  of  an  object  is  influenced  by  the  infantile 
inclination  of  the  child  towards  its  parents  and 
nurses  which  is  revived  at  puberty  and  similarly 
directed  by  the  incest  barriers  against  these  per- 
sons which  have  been  erected  in  the  meantime. 

Both  these  essential  changes  at  puberty,  the  pri- 
macy of  the  genital  zone  and  the  finding  of  an  ob- 
ject, are  indispensable  for  the  establishment  of  a 
normal  sexual  life.  If,  on  account  of  patholog- 
ical heredity  and  accidental  experiences,  this 
amalgamation  of  the  excitations  springing  from 
various  sources  and  its  application  to  the  sexual 
object  does  not  occur,  then  there  results  the  path- 
ological deviations  of  the  sexual  instinct,  deter- 
mined in  part  by  earlier  processes,  such  as  a  pres- 
ervation of  a  definite  part  of  the  original  poly- 
morphous-perverse tendency.  The  perversions 
are  thus  developed  from  seeds  which  are  present 
in  the  undifferentiated  tendencies  of  the  child  and 
constitute  in  adults  a  condition  of  arrested  devel- 
opment. 

Puberty  is  also  the  period  in  which  the  develop- 
ment of  the  two  sexes  widely  diverges  in  respect 
to  the  new  sexual  aim.  That  of  the  male  is  of  the 
more  far  reaching  influence,  while  in  the  female, 
a  kind  of  retrograde  process  sets  in.  The  auto- 
erotic  activity  of  both  sexes  has  been  the  same, 

as  on  the  nature  of  pleasure  in  general  is  found  in  Freud's  work 
"Der  Witz  und  seine  Beziehung  zum  Unbewussten"  (Lit.  No.  19). 


THE  SEXUAL  INSTINCT  59 

and  in  respect  to  the  manifestation  of  masturba- 
tion in  the  genital  zone  one  could  make  the  state- 
ment that  the  sexuality  of  the  little  girl  has 
throughout  a  masculine  character.  The  chief 
erogenous  zone  in  the  female  child  is  situated  in 
the  clitoris,  the  homologue  of  the  glans  of  the 
male  penis.  This  excitability  of  the  clitoris, 
however,  at  puberty,  which  brings  a  great  in- 
flux of  libido  to  the  boy,  undergoes  a  new  re- 
pression. Thus,  it  is  a  characteristic  of  male 
sexual  life  which  the  repression  thereby  destroys. 
The  transference  of  the  excitability  of  the  cUtoris 
to  the  vaginal  entrance  often  takes  a  certain 
time  for  its  accomplishment  during  which  the 
young  woman  is  often  anesthetic  for  coitus. 
If  the  clitoris  zone  attempts  to  retain  the  great 
activity  which  it  had  in  childhood  and  refuses 
to  give  up  its  excitability,  then  the  anesthesia  be- 
comes permanent.  In  this  vicissitude  of  the  chief 
erogenous  zone  as  well  as  in  the  new  increase  of 
repression  at  puberty  lie  the  chief  conditions  for 
the  predisposition  of  the  woman  for  a  neurosis, 
especially  hysteria.  If  one  would  give  a  definite 
meaning  to  the  terms  masculine  and  feminine,  he 
could  make  the  assertion  that  libido  is  regularly 
and  lawfully  a  masculine  attribute  whether  it  oc- 
curs in  man  or  woman  and  not  taking  its  object 
into  account  which  may  be  either  man  or  woman. 


60   FREUD'S  THEORY  OF  THE  NEUROSES 

B.     Deviations  of  the  Sexual  Instinct 

By  the  aid  of  the  analytic  investigation  of  the 
sexual  instinct  in  the  neurotic,  Freud  has  been 
able  to  interpret  exhaustively  the  pathological 
deviations  of  the  instinct  of  sex  and  to  indicate  its 
relation  to  the  normal.  These  deviations  are  not 
to  be  considered  a  priori  pathological,  but  only  in 
their  exclusiveness  and  fixation  lies  the  justifi- 
cation for  considering  the  so-called  perversions 
symptoms  of  disease.  Freud  has  greatly  illu- 
minated this  extended  field  of  phenomena,  in  do- 
ing which  he  divides  the  perversions  into  two 
groups,  according  as  the  deviation  concerns  the 
sexual  object  or  the  sexual  aim. 

1.  Deviations  in  Respect  to  the  Sexual  Object. 
'. — Among  these,  inversion,  as  Freud  calls  homo- 
sexuality, shows  the  greatest  diversity  and  there- 
fore the  most  difficult  problems.  The  persons 
having  this  perversion  are  either  {a)  absolutely 
inverted,  that  is,  their  sexual  object  can  belong 
only  to  the  same  sex;  (fe)  amphigenously  in- 
verted (psycho-sexual  hermaphrodites),  that  is, 
their  sexual  object  can  belong  to  the  same  sex 
or  to  the  opposite  sex;  (c)  occasionally  inverted. 
[A  satisfactory  explanation  of  inversion  is  af- 
forded only  by  the  perception  that  there  is  in  ev- 
ery one  an  original  bisexual  tendency  which  is  also 
estabhshed  anatomically /j^  Normal  development 


THE  SEXUAL  INSTINCT  61 

leads  from  bisexuality  to  the  primacy  of  the 
heterosexual  instinct ;  thus,  inversion  corresponds 
to  a  disturbance  of  development.  In  this  per- 
ception, the  inadequate  question  of  whether  it  is 
inborn  or  acquired  disappears.  It  arises  un- 
doubtedly in  earliest  childhood  and  has  as  a 
foundation,  disturbances  which  the  sexual  instinct 
encounters  in  its  development.  In  every  case, 
it  is  absolutely  inadmissible  to  differentiate  a 
special  homosexual  instinct ;  it  is  not  a  peculiar- 
ity of  the  instinctive  life  but  of  the  choice  of  an 
object  which  constitutes  the  homosexual.  The 
problem  of  homosexuality  is  a  very  involved  one 
and  embraces  quite  different  types  of  sexual  ac- 
tivity and  development.  One  should  expressly 
distinguish  whether  the  inversion  has  inverted  the 
sexual  character  of  the  object  or  that  of  the  sub- 
ject. The  sexual  object  of  the  male  invert  is 
frequently  not  of  the  same  sex  in  his  essential 
characteristic  but  a  union  of  the  characteristics  of 
both  sexes  with  the  fixed  condition  of  masculin- 
ity of  body  (genitals) .  The  analysis  of  the  pho- 
bia of  a  five  year  old  boy  brought  Freud  the  expla- 
nation of  this  condition.  One  finds  among  homo- 
sexuals in  later  life,  who  according  to  Freud's 
and  Sadger's^^  observations  pass  through  in  child- 

12  J.  Sadger:  "Fragment  der  Psychoanalyse  eines  Homosex- 
uellen"  (Jahrb,  f,  sex.  Zwisclienstufen,  1908).  Same,  "Zur 
Atiologie  der  kontraren  Sexualempfmdung'*  {Mediz,  Klinik,  1909). 


62      FREUD'S  THEORY  OF  THE  NEUROSES 

hood  an  amphigenous  stage,  the  same  infantile 
overvaluation  of  the  genitals,  especially  of  the 
penis  as  distinguished  this  Httle  patient.  This 
premature  preponderance  of  the  masculine  organ 
determines  the  fate  of  the  homosexual.  They 
choose  the  woman  as  the  sexual  object  in  their 
childhood  so  long  as  they  presuppose  in  woman 
the  existence  of  that  part  of  the  body  which  is 
apparently  indispensable  to  them;  with  the  con- 
viction that  the  woman  has  deceived  them  in  this 
point,  the  woman  ceases  to  be  acceptable  as  sex- 
ual object.  They  cannot  do  without  the  penis 
on  the  person  who  should  stimulate  them  to  sex- 
ual intercourse  and  in  favorable  cases  fix  their 
libido  upon  the  "woman  with  the  penis,"  the  youth 
of  effeminate  appearance.  The  homosexuals 
have  thus  remained  fixed  during  the  course  of  de- 
velopment from  autoeroticism  to  love  of  an  object 
in  a  position  nearer  autoeroticism.  The  presup- 
position of  a  penis  on  the  woman  is  one  of  those 
frequent  infantile  sexual  theories  developed  by 
the  still  unenlightened  child  whose  sexual  curios- 
ity is  already  awakened. 

Although  psycho-analysis  has  as  yet  furnished 
no  complete  explanation  of  the  origin  of  inver- 
sion, still  it  can  disclose  the  psychic  mechanism  in 
certain  cases  and  enrich  the  discussion  concerning 

Same,  "1st  die  kontrare  Sexualempfindung  heilbar?"  (Zeitschr,  f, 
Sexualvnssenschaft,  1908). 


THE  SEXUAL  INSTINCT  6S 

this.  In  the  cases  thus  far  investigated,  it  can  be 
asserted  that  those  who  later  become  inverted  pass 
through  during  the  first  years  of  childhood  a 
phase  of  very  intense  but  short-lived  fixation  on 
the  woman  (usually  the  mother),  after  the  con- 
clusion of  which  they  identify  themselves  with  the 
woman  and  take  themselves  for  the  sexual  object, 
that  is,  proceeding  from  narcism,  they  seek  young 
men  like  their  own  person  whom  they  wish  to  love 
as  the  mother  loved  them.  In  this  connection,  it 
has  been  discovered  that  the  supposed  inverted 
were  in  no  way  insusceptible  to  the  stimulus  of 
the  woman  but  the  excitement  called  forth  by  the 
woman  is  continually  transposed  to  a  male  ob- 
ject. Thus  they  repeat  during  their  whole  life 
the  mechanism  by  which  their  inversion  was  occa- 
sioned. Their  obsessional  striving  after  the  man 
shows  itself  as  conditioned  by  their  restless  flight 
from  the  woman.  Meanwhile,  it  is  to  be  noticed 
that  thus  far  psycho-analysis  has  undertaken  to 
analyze  only  a  few  types  of  inversion:  persons 
with  generally  restricted  sexual  activity  whose 
sexuaUty  is  exhibited  as  inversion.  The  develop- 
ment of  homosexuality  seems  further  to  be  fa- 
vored for  both  sexes  by  purely  feminine  surround- 
ings during  the  period  of  growth. 

Exceptionally,  sexually  immature  persons  and 
animals  may  also  be  taken  as  sexual  objects,  thus 
throwing  a  light  on  the  nature  of  the  sexual  in- 


64»   FREUD'S  THEORY  OF  THE  NEUROSES 

stinct  which  in  contrast  to  hunger  permits  of  so 
many  kinds  of  variations  and  such  a  degradation 
of  its  object. 

2.  The  deviations  in  respect  to  the  sexual  aim 
which  are  described  as  perversions  Freud  divides 
into  (a)  anatomic  transgressions  of  the  portions 
of  the  body  appointed  for  the  sexual  union;  (&) 
lingering  over  the  intermediary  relations  to  the 
sexual  object  which  should  normally  be  passed 
through  quickly  on  the  way  to  the  final  sexual 
goal.  In  the  most  normal  sexual  process,  those 
steps  are  already  discernible,  the  development  of 
which  leads  to  the  deviations  which  are  called 
perversions. 

(a)  The  psychic  valuation  which  the  sexual 
object  shares  as  the  wish-goal  of  the  sexual  in- 
stinct is  limited  in  the  rarest  cases  to  the  genitals 
but  usually  encroaches  on  the  whole  body  and 
radiates  to  the  psychic  field.  It  is  this  psychic 
''sexual  overvaluation"  which  endures  so  badly 
the  limitation  of  the  sexual  aim  and  helps  to  bring 
other  parts  of  the  body  to  serve  as  sexual  goals. 
In  the  elaboration  of  these  most  varied  anatomical 
transgressions,  a  need  for  variation  is  unmistak- 
able. The  importance  of  the  agency  of  sexual 
overvaluation  may  be  best  studied  in  the  man 
whose  sexual  life  is  open  to  investigation  while 
that  of  the  woman  in  part  because  of  cultural 


THE  SEXUAL  INSTINCT  65 

limitation,  in  part  through  conventional  conceal- 
ment and  insincerity  is  hidden  in  darkness. 

The  application  of  the  lip  and  mouth  mucosa  to 
the  normal  kiss  is  generally  practiced  among  most 
peoples.  On  the  contrary,  against  the  union  of 
the  lip-mouth-zone  with  the  sexual  organ  of  the 
other  sex  there  are  various  strong  feelings  of  dis- 
gust. In  this  disgust,  Freud  sees  one  of  the 
forces  which  have  brought  about  the  limitation  of 
the  sexual  aim.  As  a  rule,  these  stop  short  of 
the  genitals.  However,  if  the  genitals  become!  p  ^^ 
the  object  of  the  disgust  (sexual  refusal)  this  is  |  f^ 
to  be  considered  a  characteristic  sign  of  hysteria  \ 
( especially  among  females ) .  In  connection  with 
this,  it  may  be  noted  that  with  hystericals,  certain 
other  portions  of  the  body,  as  mouth  and  anal 
mucosa,  may  assume  as  it  were  the  significance 
and  role  of  genitals. 

Freud  brings  into  connection  with  the  sexual 
overvaluation  the  common  abnormality  of  fetich- 
ism.  The  f etichistic  substitute  for  the  sexual  ob- 
ject is  in  general  a  part  of  the  body  only  slightly 
adapted  to  the  sexual  purpose  (foot,  hair)  or  an 
inanimate  object  which  stands  in  near  relation  to 
the  sexual  person  (pieces  of  clothing,  linen,  shoes, 
etc).  A  certain  degree  of  fetichism  is^always 
pecuhar  to  normal  love.  This  first  becomes  path- 
ological when  the  striving  after  the  fetich  be- 


66      FREUD'S  THEORY  OF  THE  NEUROSES 

comes  fixed  and  takes  the  place  of  the  normal 
goal.  Fm^ther,  when  the  fetich  becomes  sepa* 
rated  from  the  definite  person  and  becomes  the 
sole  sexual  object.  A  certain  diminution  in  the 
desire  for  the  normal  sexual  goal  seems  to  be  a 
presupposition  for  all  cases  (executive  weakness 
of  the  sexual  apparatus).  In  the  choice  of  the 
fetich,  there  is  shown,  as  Binet  first  asserted  and 
as  was  later  affirmed  by  numerous  proofs,  the  per- 
sisting influence  of  a  sexual  impression  usually 
received  in  early  childhood.  In  other  cases,  it  is 
a  symbolic  association  of  thoughts  usually  not 
conscious  to  the  individual  which  has  influenced 
the  substitution  of  the  object  by  the  fetich. 
Psycho-analysis  could  recently  fill  out  the  pre- 
vious gaps  in  the  understanding  of  fetichism  by 
pointing  out  the  significance  of  a  pleasure  derived 
from  smell  (Riechlust)  for  the  choice  of  the  fetich 
which  has  been  lost  through  repression.  Feet 
and  hair  are  peculiarly  odoriferous  objects  which 
after  the  renunciation  of  the  pleasure  derived 
from  the  smell  and  corresponding  idealization 
are  raised  to  fetiches.^^  In  the  perversion  cor- 
responding to  the  foot-fetichism,  the  bad-smell- 
ing foot  is  accordingly  the  original  sexual  object. 
Another  contribution  to  the  explanation  of  fetich- 
is  This  conception  is  confirmed  by  an  investigation  by  Abraham 
on  a  case  of  shoe  and  corset  fetichism  (Jahrbuch,  1910).  For 
pleasure  in  smelling,  compare  Jahrbuch,  I,  2,  page  420. 


THE  SEXUAL  INSTINCT  67 

istic  preference  for  the  foot  is  revealed  in  the  in- 
fantile sexual  theories  to  be  discussed  later;  the 
foot  represents  the  greatly  missed  penis  of  the 
woman.^^ 

(b)  Fixations  of  temporary  sexual  goals. 
All  external  and  internal  conditions  which  render 
difficult  the  attainment  of  the  normal  sexual  aim 
or  long  defer  it  (impotence,  costliness  of  the  sex- 
ual object,  dangers  of  the  sexual  act)  strengthen 
the  tendency  to  prolong  the  preparatoiy  acts  and 
form  new  sexual  goals  from  these  which  may  re- 
place the  normal.  Closer  investigation  always 
shows  that  the  apparently  most  strange  of  these 
new  purposes  are  already  hinted  at  in  the  normal 
sexual  process  and  provided  by  the  intimacies 
which  serve  for  the  excitement  of  themselves  and 
the  opposite  party.  In  this  respect,  the  fondling 
of  the  sexual  object  plays  the  greatest  role.  A 
certain  amount  of  fondling  and  a  prolongation  of 
the  intermediary  sexual  goal  of  sexually  toned 
looking  at  is  present  in  a  certain  degree  in  most 
normal  men.  The  pleasure  of  looking  (Schau- 
lust)  becomes  a  perversion  {a)  when  it  is  limited 
exclusively  to  the  genitals,  (b)  when  it  is  joined 
with  the  overcoming  of  the  disgust  (voyeurs, 
peepers),  onlookers  at  the  excretory  functions, 

14  The  foot  is  an  ancient  symbol  of  the  penis  long  used  in  myths 
and  corresponding  to  the  shoe  or  slipper  symbol  of  the  female 
genitals.  Compare  Aigremont,  "Schuh-  und  Fuss-Fetichismus  wid 
Erotik,"  Leipzic,  1909. 


68   TREUD'S  THEORY  OF  THE  NEUROSES 

(c)  when  it  represses  the  normal  sexual  goal  in- 
stead of  preparing  for  it.  The  latter  is  shown 
most  clearly  in  the  case  of  the  exhibitionists  who 
display  their  genitals.  In  this  perversion  there 
stands  forth  most  distinctly  a  curious  trait  which 
is  also  sometimes  present  in  other  perversions. 
The  sexual  goal  is  really  present  here  in  double 
form,  in  active  and  passive  form.  Thus,  these 
instincts  appear  in  contrasting  pairs.  The  same 
is  the  case  in  one  of  the  most  frequent  and  im- 
portant of  the  perversions,  in  the  instinct  to  in- 
flict pain  on  the  sexual  object  (sadism)  and  its 
opposite  (masochism)  also  called  active  and  pas- 
sive algolagnia. 

C     The  Sexual  Instinct  of  'Neurotics 

The  results  which  have  come  to  Freud  from  the 
conditions  described  are  intimately  connected  with 
the  starting  point  of  his  theory,  since  they  have 
afforded  an  important  point  of  view  for  under- 
standing the  sexual  instinct  of  neurotics.  Neu- 
rotics are  really  persons  with  strongly  formed 
impulses  which  have  in  the  course  of  development 
been  repressed  and  unconsciously  become  per- 
verse. Their  sexual  instinct  displays,  therefore, 
all  the  deviations  which  we  have  studied  as  varia- 
tions of  the  normal  and  as  expressions  of  the  path- 
ological sexual  life  and  their  unconscious  phanta- 
sies show  during  the  process  of  rendering  these 


THE  SEXUAL  INSTINCT  6d 

conscious  by  analysis  the  same  content  as  the  JSxed 
acts  of  the  perverts. 

(a)  In  the  unconscious  mental  life  of  all  neu- 
rotics without  exception,  are  found  impulses  to 
inversion,^^  fixation  of  the  libido  on  persons  of 
the  same  sex,  a  discovery  which  is  of  espe- 
cial importance  for  the  elucidation  of  hysteria 
in  males. 

(b)  Among  the  psychoneurotics  may  be  de- 
tected all  the  tendencies  to  the  anatomic  trans- 
gressions existing  in  the  unconscious  as  symptom- 
creators  ;  among  such  occurring  with  especial  fre- 
quency and  intensity  are  those  which  convert  the 
oral  and  anal  mucosa  to  the  role  of  genitals. 

(c)  A  most  important  role  among  the  symp- 
tom-creators of  the  psychoneuroses  is  played  by 
the  component  instincts  which  were  discussed  as 
creators  of  the  new  sexual  goal;  these  appear 
mostly  in  contrasting  pairs,  the  peeping  tendency 
and  the  exhibitionistic  tendency,  the  active  and 
passive  tendency  to  cruelty.  The  contribution 
of  the  latter  is  indispensable  to  the  comprehen- 
sion of  the  painful  nature  of  the  symptoms  and 
almost  invariably  controls  a  part  of  the  social  re- 
lations of  the  patients.  Where  such  an  instinct 
which  is  capable  of  being  paired  with  an  opposite 
is  foimd  in  the  unconscious,  the  second  part  may 

15  Compare  Alf.  Adler,  "Der  psychische  Hermaphroditismus  im 
Leben  und  in  der  Neurose,"  Fortschritte  d.  Medizin,  1910. 


70      FREUD'S  THEORY  OF  THE  NEUROSES 

regularly  be  detected  as  acting.  Every  active 
perversion  is  thus  accompanied  by  its  passive 
counterpart.  For  example,  whoever  has  diffi- 
culty in  following  the  repression  of  sadistic  im- 
pulses, finds  another  entrance  to  the  symptoms  by 
way  of  the  masochistic  tendency.  The  complete 
agreement  with  the  conduct  of  the  corresponding 
positive  perversions  is  certainly  very  noteworthy. 
In  the  clinical  picture,  however,  one  or  the  other 
of  the  contrasting  tendencies  plays  the  paramount 
role. 

In  a  clear  case  of  psychoneurosis,  there  is  sel- 
dom only  one  of  these  perverse  tendencies  pres- 
ent, usually  a  large  number  of  them  and  as  a 
rule  traces  of  all. 

The  sexuality  of  neurotics  discloses  one  kind 
of  repression  of  the  instinctive  life  which  exceeds 
the  normal  amount.  The  symptoms  of  the  neu- 
rotic malady  are  the  expression  of  the  sexual  ac- 
tivity of  the  patients  taken  in  the  broadest,  poly- 
morphous-perverse sense.  Thus  they  originate 
not,  as  a  mistaken  conception  of  the  Freudian 
doctrine  insists,  only  at  the  expense  of  the  so- 
called  normal  sexual  instinct,  but  represent  the 
converted  expression  of  instincts  which  one  must 
call  perverse    (in  the  broadest  sense ).^^      The 

16  Compare  W.  Strohmayer,  "Zur  Analyse  und  Prognose  psycho- 
neurotischer  Symptome,"  Zeitschr.  f.  Psi/chotherapie  u.  m«d, 
Fsychologie,  II,  2,  1910. 


THE  SEXUAL  INSTINCT  71 

neurotics  have,  in  a  certain  sense,  kept  the  in- 
fantile attitude  toward  sexuahty  or  would  go  back 
to  it,  but  with  the  difference  that  with  neurotics 
the  sexual  instinct  is  not  expressed  consciously 
and  actively  but  exists  in  repression,  thus  acting 
in  the  unconscious  and  there  finding  expression 
only  in  the  form  of  inhibitions.  The  neurosis 
may  thus  be  called  the  negative  of  the  perversion. 
With  such  a  conception  naturally  disappears  the 
contradiction  that  there  may  be  persons  whose 
sexual  life  has  ceased  who  may  yet  contract  a 
neurosis;  one  should  not  forget  that  there  may 
be  a  number  of  perverse  emotions,  the  deficient 
gratification  of  which  leads  to  a  neurosis  in  the 
end. 

The  sexual  instinct  of  the  neurotic  expresses 
itself  before  everything  else  in  a  spontaneous  sex- 
ual precocity  which  shows  itself  in  the  interrup- 
tion, shortening  or  abolition  of  the  infantile  latent 
period.  This  precocity  renders  difficult  the  later 
control  of  the  sexual  instinct  and  confers  upon  it 
a  certain  amount  of  obsessional  character.  It 
leads  further  to  an  excessive  development  of  the 
sexual  instinct  against  which,  on  the  other  hand, 
the  abnormal  (failed)  repression  stands  opposed. 
Between  the  pressure  of  the  instinct  and  the 
counter  pressure  of  the  sexual  denial,  the  mal- 
ady then  makes  its  appearance  as  a  way  out  which 
does  not  solve  the  conflict  but  seeks  to  escape  it 


72      FBEUD'S  THEORY  OF  THE  NEUROSES 

by  changing  the  libidinous  tendencies  into  symp- 
toms. 

These  were  the  results  which  Freud  had  gained 
from  psycho-analytic  investigation  of  adults  and 
some  isolated  cases  of  observations  of  children. 
In  an  especially  favorable  and  because  of  its 
youthful  age  most  suitable  case,  he  succeeded  later 
in  confirming  directly  this  insight  into  the  nature 
of  child  sexuality  which  had  been  established 
retrospectively.  Since  the  neuroses  of  adults 
were  to  be  traced  back  in  every  case  to  the  same 
basic  complexes  as  those  the  child  showed  in  com- 
plete distinctness  and  elaboration,  Freud  could 
claim  for  this  child-neurosis  a  typical  significance. 
This  child  analysis  showed  positively  that  the  pic- 
ture of  the  child's  mental  life  as  it  was  presented 
from  the  observation  of  the  little  patient  by  his 
parents  was  in  complete  accord  with  the  descrip- 
tion which  Freud  had  sketched  in  his  sexual  the- 
ory from  psycho-analytic  investigations  of  adults 
and  at  that  time  only  occasional  observations  on 
children.  In  the  boy's  relation  to  his  father  and 
mother,  this  case  confirmed  in  every  detail  every- 
thing which  Freud  had  asserted  concerning  the 
sexual  relations  of  children  to  their  parents. 
The  boy  is  a  little  CEdipus  who  would  have  the 
father  out  of  the  way  in  order  that  he  might 
be  alone  with  the  beloved  mother   and  sleep 


THE  SEXUAL  INSTINCT  73 

with  her.  Besides  this  typical  CEdipus-com- 
plex  ^^  of  sensuous  love  for  the  mother  with  an- 
tipathy against  the  father  and  wishes  for  his 
removal,  the  greatest  influence  on  the  psycho- 
sexual  development  of  the  patient  was  exerted 
by  the  birth  of  a  sister  when  he  was  three  and 
a  half  years  old.  This  event  had  intensified  his 
relations  to  the  parents,  placed  insoluble  prob- 
lems in  his  thoughts  and  the  observation  of  the 
nursing  of  the  newborn  child  revived  the  memory 
traces  of  his  own  earliest  pleasurable  experiences. 
This  influence  is  also  a  typical  one;  in  an  unex- 
pectedly large  number  of  life-  and  clinical  his- 
tories, one  must  consider  this  flaming  up  of  sex- 
ual pleasure  and  curiosity  which  is  connected  with 
the  birth  of  the  next  child  as  the  starting  point  of 
the  understanding.  The  desire  for  knowledge  in 
children  does  not  in  general  awaken  sponta- 
neously but  under  the  instigation  of  the  instinct 
of  jealousy,  when  at  about  the  end  of  the  second 
year  they  are  met  by  the  arrival  of  a  new  child. 
The  justly  feared  ending  of  the  parental  care  has 
an  awakening  influence  on  the  emotional  life  of 
the  child  and  stimulates  his  powers  of  thought.^^ 
Under   the   excitation   of   these   emotions   and 

17  Concerning  the  expression  of  this  complex  in  the  dream,  com- 
pare Chapter  V. 

18  The  elder  child  often  expresses  his  enmity  against  the  new 
arrival  quite  openly. 


74   FREUD'S  THEORY  OF  THE  NEUROSES 

troubles,  the  child  comes  into  contact  with  the  first 
great  problem  of  life  and  raises  the  question 
whence  come  the  children,  which  is  usually- 
couched  in  the  form:  whence  comes  this  partic- 
ular disturbing  child.  If  the  child,  after  his  im- 
availing  and  unsatisfactory  investigation,  turns 
to  adults  for  information,  he  receives  either  no 
answer  or  no  sufficient  answer  or  a  rebuke  for 
his  unseemly  curiosity  or  he  will  be  put  off  with 
the  mythologically  ^^  important  information  that 
the  stork  brings  the  children  out  of  the  water. 
As  a  rule,  the  children  give  this  stork  fable  no 
credence,  since  the  pregnancy  of  the  mother  sel- 
dom escapes  their  sharp  observation.  On  the 
contrary,  they  build  false  theories  ^^  of  the  genera- 
tion and  birth  of  this  child  which  plainly  grew  in 
the  body  of  the  mother.  Ignorance  of  the  female 
genitals  enables  a  boy  to  form  a  theory  whereby 
the  fetus  is  expelled  as  an  excrement  from  the 
anus  (cloacal- theory) ;  others  suppose  it  comes 
out  through  the  navel,  to  which  they  can  assign 
no  other  function.  These  theories  naturally  al- 
low the  possibility,  for  they  overlook  the  peculi- 
arities of  the  female  genitals,  of  both  sexes  bear- 
ing children,  which  idea  really  plays  a  great  role 

i»See  Rank,  "Der  Mythus  von  der  Geburt  des  Helden'* 
(Schriften  z.  angewandten  Seelenkunde,  Part  5,  F.  Deuticke, 
Vienna  and  Leipzic,  1909). 

20  Compare  Freud:  "Uber  infantile  Sexualtheorien,"  Lit.  No.  32. 


THE  SEXUAL  INSTINCT  75 

in  childish  phantasy-life.  In  general,  the  still 
incomplete  recognition  of  or  disbelief  in  two  dif- 
ferent sexual  apparatuses  furnishes  the  child  a 
weighty  problem  for  childish  thinking  and  inves- 
tigation and  is  solved  at  first  by  the  assumption 
that  the  female  sex  possess  a  penis.  The  griev- 
ous later  results  of  this  sexual  theory  have  al- 
ready been  mentioned  under  homosexuality.  To 
this  misunderstanding  concerning  the  external 
genitals  is  joined  a  comprehensive  generation 
phantasy,  for  example,  the  maiden's  phantasy 
that  generation  is  accomplished  by  a  mere  kiss. 
The  children  also  often  think  of  the  condition  of 
wedlock  in  a  childish  naive  manner  as  a  pleasure- 
giving  affair  which  pays  little  attention  to  shame 
and  disgust,  most  frequently  in  the  form  that  the 
man  and  woman  unceremoniously  urinate  before 
each  other  or  show  their  posterior  parts.  Ex- 
ceedingly often,  the  children  arrive  at  a  sadistic 
conception  of  coitus  and  the  boys  usually  consider 
it  a  row  to  which  the  overhearing  of  the  noisy  ac- 
complishment of  the  act  by  adults,  mostly  the 
parents,  with  its  loud  breathing,  misleads  them. 
It  must  be  asserted  that  all  these  childish  theories 
are  of  still  greater  value  within  the  neuroses 
themselves  and  exert  a  determining  influence  on 
the  formation  of  the  symptoms. 

Thus,  the  content  of  the  child's  psycho-sexual- 
ity consists  in  the  autoerotic  activity  of  the  pre- 


76      FREUD'S  THEORY  OF  THE  NEUROSES 

dominating  sexual  components,  in  traces  of  love 
of  an  object  and  in  the  formation  of  that  complex 
which  Freud  has  called  the  nuclear-complex  of 
the  neuroses  which  embraces  the  first  affectionate 
as  well  as  hostile  emotions  toward  the  parents  ^^ 
and  brothers  and  sisters.  From  the  uniformity 
of  this  content  and  the  constancy  of  the  influ- 
ences which  later  modify  it,  the  statement  may  be 
made  that  in  general  the  same  phantasies  con- 
cerning childhood  are  always  formed.  Thus,  the 
neurotics  are  not  to  be  sharply  differentiated 
from  the  normal  and  especially  in  childhood  are 
not  always  to  be  distinguished  from  those  who 
remain  healthy.  On  the  contrary,  it  is  one  of  the 
most  valuable  results  of  psycho-analytic  investi- 
gations that  the  neuroses  are  shown  to  have  no 
special  characteristic  mental  content  peculiar  to 
themselves,  but  that  the  neiu-otics,  as  Jung  ex- 
presses it,  are  incapacitated  by  the  same  com- 
plexes with  which  the  healthy  struggle.  The  dif- 
ference is  that  the  healthy  know  how  to  control 
these  complexes  without  gross  visible  injuries 
while  for  the  neurotics,  the  suppression  of  these 

21  The  way  in  which  the  persons  in  authority  in  the  family  serve 
as  models  for  the  whole  character  development  and  determination 
of  the  fate  of  healthy  as  well  as  neurotic  individuals  can  not  be 
discussed  in  detail  here.  Reference  can  only  be  made  to  the  im- 
portant works  of  Jung,  "Die  Bedeutung  des  Vaters  fiir  das 
Schicksal  des  Einzelnen,"  and  Abraham,  "Die  Stellung  der  Ver- 
wandtenehe  in  der  Psychologic  der  Neurosen"  (both  in  Jahrbuch, 
I,  1909). 


THE  SEXUAL  INSTINCT  77 

complexes  is  accomplished  only  at  the  price  of 
costly  substitute  structures,  thus  practically  fail- 
ing. 

In  still  another  respect  was  the  case  of  that 
five-year-old  patient  interesting.  Namely,  he 
showed  in  all  distinctness  what  Freud  had  then 
found  and  announced  in  a  case  of  obsessional 
neurosis,^^  that  a  completely  formed  psycho- 
neurosis  can  be  met  with  at  an  early  age,  about 
five  or  six  years.  The  neurosis  of  the  little  fellow 
showed  itself  as  an  anxiety-hysteria  of  the  kind 
properly  classified  as  a  phobia.  /These  anxiety- 
hysterias  are,  according  to  Freud's  experience, 
not  only  the  most  frequent  of  all  psycho-neurotic 
maladies  in  general,  but  also  the  first  to  appear  in 
life,  indeed  the  neuroses  of  childhood.  Unfor- 
tunately, the  finer  mechanism  of  this  important 
malady  is  still  insufficiently  studied.  Doubtless 
now  that  attention  has  once  been  called  to  the 
neuroses  of  children,  the  publication  of  similar 
cases  will  follow  ^^  which  will  confirm  the  former 
results  and  lead  to  a  deeper  understanding  of  this 
so  important  and  interesting  pathological  mani- 
festation. 

22  Lit.  No.  36. 

23  Compare  Jung,  "Uber  Konflicte  der  kindlichen  Seele,"  Jahrb., 
II,  1,  1910. 


CHAPTER  IV 

THE   UNCONSCIOUS 

Consciousness  and  the  Unconscious.  Common  Mean- 
ing of  Unconscious.  Hypnosis  and  Double-Conscious- 
ness. The  Unconscious  in  Hysteria.  Resistance  and 
Repression.  Genesis  and  Content  of  the  Real  Uncon- 
scious. The  Complex.  The  Free  Association.  The 
Association  Experiment.  Determination  of  All  Mental 
Processes.  Phenomena  of  the  Unconscious  in  the 
Psychopathology  of  Everyday  Life.  The  Unconscious 
in  Wit  and  Dream  Formation. 

The  basic  presupposition  for  an  intelligent 
penetration  into  the  secrets  of  hysteria  is  the 
recognition  of  the  nature  and  activity  of  uncon- 
scious mental  life.  As  an  obstacle  to  apprecia- 
ting this,  stands  preeminently  the  conception  of 
the  prevailing  school-psychology  for  which  every- 
thing psychic  is  a  priori  only  conscious,  hence  the 
speaking  of  unconscious  mental  processes  consti- 
tutes an  absolute  absurdity.^  The  observa- 
tions of  the  psycho-analysts,  however,  compel 

iThis  brusque  opposition  is  really  only  the  result  of  an  er- 
roneous use  of  the  word  "conscious"  for  psychic,  two  terms  whose 
meaning  is  not  identical. 

78 


THE  UNCONSCIOUS  79 

the  recognition  of  the  existence  of  unconscious 
mental  processes.  The  physician  educated  in 
psycho-analysis  can  not  do  otherwise  than  reject 
the  dogma  of  the  psychologists  that  consciousness 
is  the  indispensable  characteristic  of  mental  life 
and  hold  fast  to  his  conviction  based  on  impres- 
sions gained  from  his  observations  on  patients. 
The  results  of  psycho-analysis  really  prove  with 
every  certainty  possible  in  the  field  of  psychology 
an  unconscious  of  wide  scope  and  great  intensity. 
Right  here  it  should  be  emphasized  that  this  un- 
conscious, as  psycho-analysis  has  revealed  it,  has 
nothing  to  do  with  the  term  unconscious  as  em- 
ployed in  ordinary  speech  usage.  This  conven- 
tional ''unconscious"  signifies  as  much  as  ''unin- 
tentional," "involuntary"  or  it  indicates  psychic 
elements  of  which  one  has  not  just  thought, 
which,  however,  are  accessible  to  consciousness 
and  by  the  concentration  of  the  attention  can 
every  time  be  reproduced.^  Unconscious,  in  the 
Freudian  sense,  on  the  contrary,  means  some- 
thing which  one  does  not  really  know,  while  one 
is  compelled  in  the  analysis  by  conclusive  infer- 
ences to  recognize  it,. 

As  already  mentioned,  it  is  chiefly  the  investi- 
gations on  neurotics  which  convince  the  analyst 

2  Compare  Bleuler,  "Bewusstsein  und  Assoziation."  Diag- 
nostiche  Assoziationsstudien,  ed.  by  Jung,  Vol.  I,  No.  5,  Leipzic, 
1906,  J.  A.  Earth. 


80      FREUD'S  THEORY  OF  THE  NEUROSES 

of  the  existence  of  the  unconscious.  Neverthe- 
less, there  are  certain  other  phenomena  closely  re- 
lated to  the  neuroses  suited  to  demonstrate  in  a 
much  easier  way  the  activity  of  the  imconscious 
mental  forces.  Observers  must  recognize  that 
there  may  be  in  one  and  the  same  individual  many 
mental  groupings  which  can  remain  fairly  inde- 
pendent of  one  another,  knowing  nothing  of  one 
another  and  alternately  sphtting  consciousness. 
Cases  of  this  kind,  which  are  called  double  per- 
sonality or  multiple  personality,  occasionally 
come  to  observation  in  patients  spontaneously. 
If  in  such  a  splitting  of  personality  the  conscious- 
ness remains  constantly  joined  to  one  of  the  two 
conditions,  then  this  is  called  the  conscious  mental 
condition,  the  one  separated  from  it,  the  un- 
conscious. In  the  recognized  phenomenon  of  the 
so-called  post-hypnotic  suggestion,  in  which  a 
conmiand  given  in  the  hypnotic  state  is  later 
obeyed  in  the  normal  condition,  one  has  an  excel- 
lent picture  of  the  influences  which  the  conscious 
condition  can  experience  from  processes  uncon- 
scious to  it;  taking  this  as  a  pattern,  one  may 
classify  the  experiences  of  hysteria.  Freud  made 
use  of  hypnotism  in  the  treatment  of  hysteria 
only  at  the  beginning  of  his  work  with  the  neu- 
roses; since  he  soon  discovered  that  only  a  por- 
tion of  his  patients  could  be  hypnotized,  he  de- 
cided to  work  with  the  normal  condition.    Pro- 


THE  UNCONSCIOUS  SI 

ceeding  from  the  free  associations  of  the  patients, 
he  came,  like  Breuer  in  his  noted  case  by  hyp- 
noidal  conditions,  to  the  discovery  that  those  im- 
pressions which  had  been  the  occasion  of  hys- 
terical phenomena  had  remained  in  wonderful 
freshness  and  with  their  full  affect-tone  for  a  long 
period  of  time  without  the  patient's  being  cogni- 
zant of  these  as  he  was  of  other  affairs  of  his  life. 
On  the  contrary,  these  events  are  completely 
missing  in  the  memory  of  the  patient  in  his  ordi- 
nary mental  state  or  are  present  at  most  only  in 
outline.  By  the  aid  of  the  Freudian  psycho- 
analytic technique,  it  soon  appeared  that  the  split- 
ting of  consciousness  which  is  so  frequent  in  the 
recognized  classical  cases  as  double  consciousness 
may  appear  in  every  case  of  hysteria  in  the  form 
of  a  mental  dissociation.  Thus  resulted  the 
necessity  of  localizing  somewhere  else  these  ideas 
which  were  not  present  in  consciousness  in  the 
customary  figurative  language  employed  in  the 
description  of  mental  processes.  Freud  has, 
therefore,  in  accordance  with  Lipps,^  accepted  the 
name  "unconscious."  We  speak  here  only  of 
the  narrower  meaning  of  unconscious,  as  we 
might  say  the  Freudian  unconscious  or  the  uncon- 
scious of  the  neurosis.  The  meaning  of  the  same 
can  only  become  clear  when  one  has  recognized  in 

8"Der  Begriff  des  Unbewussten  in  der  Psychologic.**    Article 
at  3d  International  Congress  for  Psychology,  Munich,  1897. 


82      FREUD'S  THEORY  OF  THE  NEUROSES 

what  way  the  sum  of  its  content  was  separated 
from  the  conscious  mental  processes.  The  pa- 
tient betrays  these  pathogenic  unconscious  mental 
impulses  only  under  great  resistance ;  a  force  pre- 
vents their  becoming  conscious  and  compels  them 
to  remain  unconscious.  One  can  only  really  ap- 
preciate the  existence  of  this  force  when  one  seeks 
in  opposition  to  it  to  bring  the  unconscious  im- 
pulses of  the  patient  into  consciousness.  On  this 
idea  of  "resistance"  (Widerstand)  Freud  has 
founded  his  conception  of  the  mental  processes 
of  hysteria.  The  same  forces  which  to-day  op- 
pose as  resistance  the  making  conscious  of  the 
unconscious,  purposely  forgotten,  must  at  one 
time  have  accomplished  this  forgetting  and  forced 
the  offending  pathogenic  experience  out  of  con- 
sciousness. Freud  named  this  process,  which  he 
supposed  djmamic,  repression  (Verdrangung), 
and  considered  it  as  demonstrated  by  the  undeni- 
able existence  of  the  resistance  (Widerstand).** 
The  repression  came  about  by  a  psychic  trau- 
matic experience  of  special  intensity  and  entire 
disagreement  with  the  mental  character  of  the  in- 
dividual— or,  as  appeared  later,  even  a  similarly 
estabhshed  wish  (instinct)  impulse — ^becoming 
engaged  in  a  kind  of  struggle  for  existence  with 
the  ethical  and  esthetic  attributes  of  the  person- 
ality and  being  thrust  out  of  the  conscious  mental 

4  Compare  Freud,  "Uber  Psychoanalyse,"  Lit.  No.  37. 


THE  UNCONSCIOUS  83 

structure  as  you  might  say  by  an  act  of  the  will.^ 
There  had  been  a  short  previous  conflict,  the  end 
of  which  was  the  repression  of  the  unbearable 
idea.  In  the  field  of  logic,  something  like  the  re- 
jection of  judgment  would  correspond  to  this 
process.  The  acceptance  of  the  unbearable  wish- 
impulse  or  a  prolonged  duration  of  the  conflict 
would  have  called  forth  a  higher  degree  of  discom- 
fort; this  discomfort  would  be  avoided  by  the  re- 
pression which  acts  as  a  kind  of  protective  mecha- 
nism of  the  mental  personality,  as  an  expression  of 
the  instinct  of  self-preservation  of  the  psychic  ego.  i  | 
The  dissociation  of  the  mind  into  conscious  and  \  f 
unconscious  is  explained  not  as  an  inborn  weak-  |  \ 
ness  (Janet)  but  as  a  dynamic  result  of  the  con- 
flict of  contending  mental  forces.  It  may  be 
mentioned  here  in  advance  that  the  repression 
tending  to  form  a  neurosis  is  one  which  has  failed 
in  so  far  that  the  repressed  wish-impulse  con- 
tinues to  exist  in  the  unconscious  and  waits,  as  it 

5  A  similar  active  process  probably  lies  at  the  bottom  of  many 
apparently  purely  automatic  forgettings.  Freud  rightly  asserts 
that  it  is  not  so  much  the  condition  of  memory  in  the  earliest 
childhood  which  needs  explanation  as  it  is  the  forgetting  of  all 
experiences  of  a  time  when  the  child  is  perfectly  capable  of  re- 
membering. Compare  in  this  connection  what  has  been  said  on 
infantile  amnesia  and  cover-memories.  On  the  purpose  of  for- 
getting in  general,  compare  Freud's  paper  on  the  psychic  mechan- 
ism of  forgetting  (Lit.  No.  12),  where  he  shows  that  a  part  of 
forgetting  occurs  automatically  but  that  frequently  automatism 
and  tendency  (or  purpose)  work  together. 


84.   FREUD'S  THEORY  OF  THE  NEUROSES 

were,  only  for  the  opportunity  to  become  active 
in  the  form  of  a  distorted  and  unrecognizable 
substitute  formation  for  the  material  repressed 
into  the  unconscious:  the  hysterical  symptom 
(compare  Chapters  VI  and  VII) . 

The  hysterical  repression  has  its  prototype  in 
that  previously  mentioned  organic  repression® 
of  the  first  instinctive  impulses  in  the  child  which 
normally  brings  to  a  close  the  earliest  period  of 
polymorphous-perverse  sexual  activity.  In  this 
there  occurs  the  submersion  into  the  unconscious 
not  only  of  individual  experiences  but  of  a  whole 
period  of  development.  The  continuation  of  cer- 
tain instinctive  impulses  which  were  originally  ac- 
companied by  pleasure  is  brought  by  the  neces- 
sary subordination  to  cultural  requirements  into 
opposition  to  the  goal  ideas  of  the  secondary 
thought  processes  and  now  causes  discomfort  or 
pain  instead  of  pleasure.  Just  this  change  of  af- 
fect constitutes  the  essence  of  repression.^  The 
material  in  repressed  instincts,  sexual  activities, 
wish-impulses  and  erotic  phantasies  forms  the 
foundation,  as  you  might  say  the  oldest  and  deep- 
est layers  in  the  structure,  of  the  unconscious. 
A  second  part  of  the  repressed  material  comes 

•  An  explanation  of  the  relation  of  this  organic  repression  to 
the  psychological  repression  is  still  lacking. 

''More  recent  treatment  of  this  is  found  in  Freud's  "Traum- 
dcutung,"  9d  ed.,  page  375,  also  Brill's  translation. 


THE  UNCONSCIOUS  85 

from  repressions  in  later  life.  This  repression  of 
later  years  comes  about  through  the  attraction  of 
the  old  nucleus  of  the  unconscious,  while  from  the 
other  side  the  repelling  forces  of  consciousness 
again  seek  to  reject  this  definite  material.  These 
forces  acting  from  both  sides  aid  the  act  of  re- 
pression which  when  successful  is  a  normal  psy- 
chological process.  Through  the  domination  of 
the  unconscious  it  can,  however,  easily  fail;  al- 
though for  the  individual  the  repression  succeeds 
here  also  since  the  repressed  material  now  ex- 
presses its  pathogenic  activity  from  the  uncon- 
scious. 

That  sum  of  primary  instinctive  impulses 
which  are  killed  by  the  original  repression,  the 
real  unconscious  in  the  Freudian  sense,  which 
furnish  the  stream  both  of  the  neurosis  and  the 
dream,  is  to  be  distinctly  differentiated  from  that 
popular  "unconscious"  mentioned  in  the  begin- 
ning, the  combination  of  automatic,  half-for- 
gotten, unintentional  mental  processes.  The 
psycho-analytic  "unconscious,"  on  the  contrary, 
contains  nothing  except  repressed  instinctive  im- 
pulses in  the  widest  sense  of  the  word,  as  well  as 
those  psychic  formations  which  appear  as  off- 
spring of  these  repressed  impulses.  Thus,  the 
nucleus  of  this  contains  the  suppressed  component 
instincts  in  so  far  as  they  were  overcome  and  dis- 
carded in  childhood.     The  sexual  disinclination 


86      FREUD'S  THEORY  OF  THE  NEUROSES 

of  the  hysterically  disposed  individual  causes  all 
later  sexual  and  erotic  experiences  to  sink  into 
the  unconscious  and  join  the  early  originally  re- 
pressed material.  The  fundamental  character- 
istic of  the  unconscious  is  thus  its  sexual  charac- 
ter, sexual  taken  in  its  broadest  sense.  Only  one 
who  has  completely  comprehended  the  theory  of 
the  neuroses  is  capable  of  understanding  the 
whole  life  power  and  indestructibility  of  the  un- 
conscious. The  force  of  this  is  shown  most 
clearly  in  the  eternally  recurring  dreams  and 
pathologically  in  the  lasting  productivity  of  the 
neurosis.  The  whole  content  of  the  unconscious 
is,  since  it  is  indestructible,  reproducible  in  full 
vividness  under  appropriate  conditions  (psycho- 
analysis) ;  in  fact,  some  prehistoric  event  of  early 
childhood,  long  gone  from  conscious  thought,  oc- 
casionally appears  so  unchanged  and  undimin- 
ished in  intensity  that  one  must  characterize  it  as 
eternal.  The  task  of  psycho-analysis  is  to  find 
the  entrance  to  the  unconscious,  which  is  also  the 
only  way  to  make  conscious  the  unconscious. 

The  difficulty  of  representing  what  is  included 
under  the  term  "unconscious"  is  especially  con- 
spicuous in  the  fact  that  when  we  speak  of  the  un- 
conscious of  a  patient,  we  understand  other 
things  besides  the  infantile  unconscious.  In 
reality,  the  later  repressed  psycho-sexual  ma- 
terial, as  one  encounters  it  in  the  patient,  is  not 


THE  UNCONSCIOUS  87 

to  be  sharply  distinguished  from  the  infantile  un- 
conscious material.  The  more  remote  descend- 
ants of  the  original  repressed  impulses  may  no 
longer  lie  at  the  bottom  of  the  mass  of  repressed 
material  and  can  often  crop  up  suddenly  in  con- 
sciousness. These  descendants  constitute  what 
might  be  called  flitting  transitions  from  conscious 
to  unconscious  and  would  be  about  the  material 
which  Freud  calls  "fore-conscious,"  something 
which  the  patient  either  knows  or  wishes  to  know 
only  momentarily,  which  with  a  little  effort,  how- 
ever, can  be  brought  to  memory.  It  has  proved 
expedient  to  call  such  groups  of  related  elemen- 
tary ideas  possessed  of  an  affect,  complexes,  fol- 
lowing the  example  of  the  Zurich  school  (Bleuler, 
Jung  and  others).  A  definite  complex  is  in 
every  case  the  occasion?  and  content  of  the 
neurosis;  it  is  the  ruling  power  in  the  diseased 
mind  and  from  whatever  point  one  examines  the 
patient,  he  comes  upon  derivatives  which  have  be- 
come conscious,  the  conscious  substitute  ideas  of 
the  repressed  complex,  hence  regularly  upon  the 
repressed  material,  since  he  is  controlled  by  the 
goal  idea  of  the  treatment  that  the  apparently 
most  innocent  and  arbitrary  thing  reported  has 
some  relation  to  the  pathological  condition.  Pro- 
ceeding from  this  presupposition,  the  analyst  has 
merely  to  pay  attention  to  the  free  associations 
of  the  patient  coming  as  it  were  from  the  psychic 


88      FREUD*S  THEORY  OF  THE  NEUROSES 

surface  to  reach  the  repressed  pathogenic  com- 
plex. 

If  it  seems  to  a  critic  arbitrary  to  consider  the 
results  obtained  from  such  imguided  associations 
as  at  all  valuable,  attention  must  be  emphatically 
called  to  the  empirically  discovered  phenomenon 
which  is  of  fundamental  importance  for  the  whole 
psycho-analytic  technique,  namely,  that  there  is 
no  accidental  course  of  association,  that  there  are 
no  *'free"  associations,  that  in  general,  in  mental 
life,  as  elsewhere  in  nature,  there  is  nothing  acci- 
dental, arbitrary,  not  related  to  a  cause,  but  that 
every  thought,  every  association,  every  mental  oc- 
currence stands  in  relation  to  its  cause,  thus  is 
determined,  or  more  exactly,  as  the  dream  investi- 
gation shows,  is  determined  from  several  sides, 
thus  is  over-determined.  This  causal  connection 
science  has  never  denied ;  Freud's  service  consists 
in  having  confirmed  it  by  psycho-analysis.  The 
Zurich  school  later  furnished  ®  experimental  proof 
of  this  truth  discovered  by  Freud,  in  the  associa- 
tion experiments.  The  association  experiment 
inaugurated  by  the  Wundt  school  for  formal  ex- 
perimental psychological  investigations,  which 
consists  in  calling  out  to  the  person  being  ex- 

« Compare  "Diagnostische  Assoziationsstudien,"  ed.  by  Jung, 
Vol.  I,  1906,  and  Vol.  II,  1910.  Jung  gives  a  comprehensive  sur- 
vey of  the  results  of  the  association  investigation  in  the  April 
number  of  Amer,  Journal  of  Psychology,  1910. 


THE  UNCONSCIOUS  89 

amined  test  words  and  registering  his  involuntary 
answers  (reaction  words),  was  elaborated  by  the 
Swiss  school  (Jung  and  others)  in  manner  of  ap- 
plication and  utilized  in  the  sense  of  the  psycho- 
analytic investigations,  so  that  now  both  meaning 
and  content  of  the  reactions  are  considered  in  re- 
lation to  the  test  word  and  to  each  other.  From 
this  resulted,  besides  other  interesting  details,  the 
fact  that  all  reaction  words  which  the  person  be- 
ing tested  gives  to  happily  chosen  test  words 
stand  in  a  close  relation  to  one  another  and  be- 
long, especially  in  neurotics,  to  the  prevailing 
thought  and  emotional  complex.  This  complex 
manifests  itself  by  quite  definite  tokens,  while  the 
reactions  disclose  it  by  the  following  peculiarities : 
Aengthened  reaction  times,  false  reactions,  dis- 
turbances of  reproduction  in  the  repetition  of  the 
experiment,  accompanying  motor  phenomena, 
apparent  contradiction,  incoherence  between  test 
word  ^  and  reaction,  etc.  These  disturbances 
which  the  complex  causes  in  the  association  ex- 
periment are  nothing  else  than  the  Freudian  "re- 
sistances" of  the  psycho-analysis.®  It  is  even 
possible  to  carry  out  in  this  field  a  physical  con- 
trol by  the  combination  of  the  association  experi- 
ment with  a  mensuration  of  the  fluctuation  of  an 

0  Compare    Jung,    "Assoziation,    Traum   und   hyst.   Symptom." 
Diag.  Assoziationsstudien,  Vol.  II,  No.  8,  1910. 


90      FREUD'S  THEORY  OF  THE  NEUROSES 

electric  current  corresponding  to  the  affect 
shown/^ 

The  association  experiment  has  thus  confirmed 
the  existence  of  the  unconscious,  the  activity  of 
the  complex,  the  specific  content  of  the  etiological 
complex  in  the  neuroses  and  hkewise  brings  ex- 
perimental proof  for  the  determinism  of  the  ap- 
parently free  associations  which  had  been  pre- 
viously asserted  by  Freud.  This  comprehen- 
sive and  demonstrable  determinism  in  all  mental 
occurrences  is  one  of  the  most  important  basic 
principles  of  the  Freudian  psychology.  It  seems 
conceivable  that  there  may  be  an  universal  hu- 
man, as  you  might  say  normal,  resistance  against 
this  limitation  of  free  will  which  may  lead  to  a  re- 
sistance against  the  whole  Freudian  theory. 

The  psycho-analytic  investigations  aided  by  the 
association  experiment  have  shown  with  absolute 
certainty  that  in  mental  phenomena  there  is  noth- 
ing little,  nothing  arbitrary,  nothing  accidental. 
In  his  book  *'Zur  Psychopathologie  des  Alltags- 
lebens"  ^^  (Psychopathology  of  Everyday  Life) 
Freud  has  turned  his  investigations  in  this  direc- 
tion, namely,  to  certain  mistakes,  such  as  forget- 
ting, errors  of  speech,  writing  and  action  and  the 

10  Compare  L.  Binswanger,  "t)ber  das  Verhalten  des  psycho- 
galvanischen  Phanoraens  beim  Assoziationsexperiment."  Diag. 
Assoz.  Stud.,  Vol.  II,  No.  11. 

11  Lit.  No.  16. 


THE  UNCONSCIOUS  91 

like,  and  could  point  out  that  these  insufficiencies 
of  our  mental  performances  as  well  as  certain  ap- 
parently aimless  performances  (symptomatic 
acts)  are  regularly  well  motivated  and  deter- 
mined by  motives  unknown  to  consciousness;  this 
is  corroborated  when  one  subjects  these  unjustly 
neglected  minor  affairs  to  a  penetrating  psycho- 
logical consideration.  The  reason  that  the  mo- 
tives for  such  unintentional  acts  are  hidden  in  the 
unconscious  and  can  only  be  revealed  by  psycho- 
analysis is  to  be  sought  in  the  fact  that  these 
phenomena  go  back  to  motives  of  which  conscious- 
ness will  know  nothing,  hence  were  crowded  into 
the  unconscious,  without,  however,  having  been 
deprived  of  every  possibility  of  expressing  them- 
selves, These  mistakes,  in  which  an  omission  has 
the  same  value  as  an  error  of  commission,  are  thus 
the  disguised  expression  of  a  mental  impulse 
which  has  remained  unconscious  and  thus  has  a 
meaning  that  appears  only  in  a  kind  of  indirect 
representation.  In  similar  manner,  Freud  could 
regularly  point  out  behind  the  wit  ^^  which  has  a 
purpose,  thought  processes  which  make  use  of  this 
characteristic  method  of  expression  in  order  to 
half  conceal,  half  reveal  impulses  remaining  un- 
conscious. 

The  most  imposing  evidence  and  far-reaching 
explanations  of  the  unconscious  psychic  processes 

12  «Der  Witz  und  seine  Beziehung  zum  Unbewussten,"  Lit  No.  19. 


92      FREUD'S  THEORY  OF  THE  NEUROSES 

in  man  are  afforded  by  the  penetrating  study  of 
the  dream  in  the  art  of  dream  interpretation 
elaborated  by  Freud.  The  scientific  dream  in- 
terpretation inaugurated  by  the  help  of  psycho- 
analytic methods  produces  the  proof  of  the  un- 
expected fullness  of  unconscious  activity  and 
thought  formation  in  the  mind  and  shows  that  all 
mental  processes  both  of  simplest  and  most  com- 
plicated character  can  go  on  unconsciously. 
Everything  conscious  has  an  unconscious  prelimi- 
nary stage ;  the  unconscious  mental  circle  appears 
as  the  greater  one  which  includes  the  lesser  one 
of  consciousness  (Lipps). 

The  speech  of  the  unconscious  is  rich  in  means 
of  expression  which  are  full  of  oddities  for  one 
who  becomes  acquainted  with  them  for  the  first 
time:  dream,  symptomatic  act,  wit,  the  peculiar 
manners  of  reaction  in  the  association  experiment, 
the  enigmatical  neurotic  symptoms  and  finally 
the  seemingly  free  association  which  seems  the 
more  harmless  and  distorted  the  farther  it  is  sepa- 
rated from  the  repressed  complex.  All  these 
phenomena  owe  their  complication  or  difficulty 
of  interpretation  to  the  circumstance  that  the  un- 
conscious can  express  itself  only  in  a  form  which 
has  been  censored  by  consciousness.  Conscious- 
ness allows  no  direct  representation  of  the  scan- 
dalous and  since  the  indirect  (censored)  repre- 
sentation contains  so  much  that  is  novel,  para- 


THE  UNCONSCIOUS  93 

doxical  and  curious  for  the  uninitiated,  so  an  in- 
telligible resistance  is  directed  against  psycho- 
analysis which  unmasks  this  secret  speech.  The 
resistance  against  this  strange  method  of  expres- 
sion of  the  unconscious  gladly  clothes  itself  in  an 
intellectual  denial  of  the  whole  Freudian  theory 
and  is  to  be  overcome  only  by  repeated  expe- 
riences which  convince  one  of  the  entire  regularity 
of  the  speech  of  the  unconscious.  Whoever 
brings  the  good  intention  to  take  this  explanation 
of  his  resistance  succeeds  best  in  the  study  of  his 
own  dreams  according  to  Freud's  directions;  he 
can  thus  convince  himself  of  the  presence  and 
power  of  his  unconscious  mental  impulses  and 
thus  succeeds  in  the  best  way  in  becoming  a  psy- 
cho-analyst. Dreams  are  really  the  first  member 
in  the  series  of  abnormal  psychic  structures,  the 
other  members  of  which,  the  hysterical  phobia, 
the  obsessional  and  delusional  idea,  occupy  the 
physician  for  practical  reasons.  Freud  may  thus 
rightly  insist  that  he  who  does  not  know  how  to 
elucidate  the  origin  of  the  dream  picture  will 
work  in  vain  for  a  comprehension  of  the  obses- 
sional and  delusional  idea.  Our  nocturnal  dream 
products  are  indeed  compatible  with  full  health 
of  waking  life  but  have  also  the  greatest  external 
similarity  and  internal  relationship  to  the  crea- 
tions of  the  insanities.  Thus  the  dream  stands  in 
the  center  not  only  of  the  Freudian  theory  but 


94      FREUD'S  THEORY  OF  THE  NEUROSES 

also  of  the  psycho-analytic  technique,  and  because 
of  its  fundamental  importance  will  be  treated  in 
the  next  chapter  in  detail  as  an  introduction  to 
the  theory  of  the  psychoneuroses  and  analytic 
therapy. 


CHAPTER  V 

THE  DEEAM 

Chief  Characteristics  of  the  Dream:  Wish-fulfill- 
ment, Sexual  Erotic  Content.  Dream  Sources. 
Dream  Distortion  (Manifest  and  Latent  Content). 
The  Dream  Making.  Interpretation  Technique:  (a) 
by  Symbolism;  (6)  by  Associations.  Technical  Rules. 
Typical  Dreams. 

Freud  came  to  take  up  the  scientific  study  of 
dreams  in  an  empirical  way  since  neurotics  who 
were  undergoing  psycho-analytic  treatment  often 
related  to  him  spontaneously  dreams  which  were 
still  intensively  occupying  them  by  day.  A 
closer  examination  of  the  content  of  these  dreams 
revealed  the  fact  that  they  stood  in  close  relation 
to  the  agencies  which  caused  the  malady  and  that 
here  again  the  infantile  sexual  roots  were  exhib- 
ited. In  this  way,  Freud  came  to  create  the 
technique  for  the  interpretation  of  dreams  corre- 
sponding in  its  main  features  to  the  psycho- 
analytic method  of  investigation;  this  has  become 
an  indispensable  part  of  the  psycho-analytic 
therapy.  The  unconscious  which  lies  at  the  bot- 
tom of  the  neurosis  betrays  itself  in  the  dream, 

95 


96   FREUD'S  THEORY  OF  THE  NEUROSES 

not  undisguised  to  be  sure,  but  in  decipherable 
manner,  so  that  the  dream  becomes  the  chief  en- 
trance, you  might  say  the  'Via  regia"  to  the  pa- 
tient's unconscious.  How  great  significance 
the  solution  of  the  ancient  dream  problem  has  for 
psychology  cannot  here  be  gone  into  in  detail; 
our  interest  here  is  only  in  the  practical  value  of 
dream  interpretation  for  the  treatment  of  the 
neuroses.  All  mechanisms  which  enter  into  the 
origin  of  neurotic  symptoms  have  also  a  share  in 
the  formation  of  the  dream.  The  incomprehensi- 
bility of  the  dream  is  therefore  the  same  as  that 
of  neurotic  symptoms;  they  are  both  the  substi- 
tute expression  for  the  sexual  material  which  has 
become  unconscious  through  repression.  In  both 
cases,  we  have  to  deal  with  incompletely  repressed 
infantile  sexual  impulses  and  later  sexual  ma- 
terial which  has  joined  these.  Besides  the  infan- 
tile and  sexual  matters  which  furnish  the  real 
dream  sources,  there  also  come  into  consideration 
as  such  sources,  the  unnoticed  daily  happenings 
(**Tagesreste")  with  their  numerous  apparently 
indiflferei^t  details;  to  superficial  observation, 
these  frequently  seem  to  control  the  dream  pic- 
ture. Somatic  stimuli  and  external  irritations 
should  not  be  overestimated  as  dream  instigators ; 
they  can  indeed  instigate  the  dream,  but  always 
serve  merely  to  clothe  the  unconscious  wishes  like 
all  other  recent  material. 


THE  DREAM  97 

After  profound  investigation  of  his  own 
dreams  and  those  of  neurotics,  Freud,  in  the  year 
1900,  could  give  in  his  "Traumdeutung"  a  de- 
tailed account  of  the  characteristics  of  the  dream. 
The  most  important  discovery  was  that  the  dream 
regularly  represents  a  wish-fulfillment,  that  is, 
it  brings  to  representation  in  dramatic  form  an 
unconscious  wish  of  the  dreamer  represented  as 
fulfilled.  In  this  an  infantile  wish  is  readily 
combined  with  an  actual  one.  The  wish  char- 
acteristic may  be  easily  recognized  in  isolated 
dreams  if  it  is  not  apparent  in  the  majority  of  the 
dreams  of  adults.  On  the  contrary,  the  dreams 
of  healthy  children  show  as  fulfilled  their  naive 
simple  wishes  which  have  been  active  by  day  and 
remained  unfulfilled.  Numerous  other  dreams, 
especially  such  as  anxiety  and  fear  dreams,  seem 
at  first  to  be  an  argument  against  the  universal 
validity  of  the  wish  theory.  Naturally  Freud 
could  not  escape  this,  but  he  has  pointed  out  that 
the  anxiety  dream  after  being  subjected  to  pene- 
trating interpretation  likewise  shows  itself  to  be 
the  representation  of  a  suppressed  (repressed) 
sexual  wish,  the  disguise  of  which  has  failed.  To 
prove  this  position,  Freud  has  undertaken  in  his 
work  the  analysis  of  a  number  of  anxiety-dreams 
and  shown  the  sexual  material  in  the  dream 
thoughts.  From  these  it  was  made  evident  that 
the  anxiety  which  we  feel  in  the  dream  is  only 


98      FREUD'S  THEORY  OF  THE  NEUROSES 

apparently  explained  by  the  content  of  the 
dream;  it  is  only  attached  to  the  accompanying 
idea  and  arises  from  other  sources.  Thus,  the 
anxiety-dreams  not  only  exhibit  a  new  side  of  the 
dream  problem  but  are  also  important  for  the 
comprehension  of  neurotic  anxiety  in  general. 
The  anxiety-dream  belongs,  therefore,  to  the 
anxiety  problem  and  will  be  further  discussed  in 
the  chapter  on  hysteria. 

One  must  not  represent  the  interpretation  and 
arrangement  of  the  dream  in  the  mental  life  of 
the  individual  as  too  simple.  What  we  remem- 
ber in  the  morning  ("the  manifest  content")  is 
mostly  a  highly  phantastic,  sometimes  paradoxi- 
cal, thought  picture  which  even  whe]?e  it  seems 
logically  composed  does  not  betray  the  real  mean- 
ing of  the  dream  ("the  latent  content").  Only 
the  interpretation  work  which  will  be  discussed  in 
detail  later  can  show  the  "latent"  thought  content 
hidden  behind  this  manifest  dream  content,  that 
is  to  say,  the  particular  unconscious  wish.  One 
must  not  be  led  astray  by  the  fact  that  the  dream 
is  joined  in  many  ways  to  the  events  and  impres- 
sions of  the  preceding  day  or  evening.  These 
connections  are  only  superficial  and  have  only 
loose,  unimportant  relations  to  the  real  dream- 
forming  complexes.  The  true  foundation  of  the 
dream  is  furnished  by  the  wishes  of  childhood 
which  have  become  unattainable  and  stored  away 


THE  DREAM  99 

in  the  unconscious;  these  have  normally  disap- 
peared into  the  unconscious  because  of  psycho- 
sexual  development.  The  particular  dream- 
forming  wishes  which  are  fulfilled  in  the  dream 
and  can  be  disclosed  only  by  the  interpretation 
work  show,  in  contrast  to  the  manifest  content,  a 
logical  and  intelligible  as  well  as  affectively  well- 
motived  train  of  thought  which  is  organically  con- 
nected with  the  rest  of  the  mental  life.  The 
manifest  dream  remembered  in  the  morning,  on 
the  contrary,  is  often  without  affect,  disconnected, 
unintelligible,  as  strange  to  the  waking  conscious- 
ness as  the  delusions  of  the  insane  are  to  the 
normal  consciousness.  Thus  one  comes  upon  the 
fact  that  tlie  dream  is  the  expression  of  those  old 
instinctive  wishes  later  felt  as  painful  (re- 
pressed), now  returned  to  life  again  distorted  by 
a  complicated  mechanism.  Freud  assumes  that 
consciousness  in  the  service  of  the  repression 
activity  of  the  ego  continues  working  in  the  dream 
as  a  kind  of  psychic  censor,  not  allowing  those  for- 
bidden impulses  to  pass  in  full  distinctness  but 
only  when  disguised  in  speech  and  form.  By 
this  cultural  limitation  the  appearance  of  painful 
emotions  which  would  accompany  the  becoming 
fully  conscious  of  the  unconscious  is  avoided  as  a 
rule  (compare  on  the  contrary  the  failure  of  this 
dream  tendency  in  the  anxiety-dream)  and  un- 
disturbed peaceful  sleep  is  protected.     Thus,  the 


100  FREUD'S  THEORY  OF  THE  NEUROSES 

dream  proves — just  the  opposite  of  the  common 
opinion — the  real  protector  of  sleep,  against 
which  the  fact  that  it  does  not  always  accomplish 
this  task  (anxiety-dreams)  in  no  way  militates. 
This  tendency  shows  plainest  in  a  group  of 
dreams  which  have  always  been  cited  in  support 
of  the  conmion  theory  that  the  dream  pictures 
owe  their  origin  merely  to  certain  physical  irri- 
tations. In  the  sense  of  the  Freudian  conception, 
a  series  of  these  dreams,  the  so-called  satisfaction- 
dreams,  afford  the  best  proof  of  two  dream  char- 
acteristics declared  by  Freud  to  be  universal, 
since  these  dreams  represent  a  bodily  need  which 
appears  in  sleep  (for  example  thirst)  as  gratified 
and  thus  serve  to  guard  sleep.,  These  dreams, 
like  children's  dreams,  also  plainly  show  the  wish- 
fulfilling  characteristic. 

It  is  nevertheless  quite  otherwise  with  that  by 
far  the  greatest  group  of  dreams  of  adults,  espe- 
cially of  neurotics,  for  the  illumination  of  which  a 
painstaking  and  complicated  interpretation  work 
is  necessary;  after  this  has  been  done,  however, 
these  dreams  also  show  the  same  characteristics. 
Now  arises  the  question,  what  are  the  mental 
processes  which  have  transformed  the  dream 
thoughts  discovered  by  painstaking  interpreta- 
tion into  the  dream  form  so  incomprehensible  to 
us  at  first.  From  the  comparison  of  the  remem- 
bered manifest  content  of  the  dream  with  the  dis- 


THE  DREAM  ICl 

covered  latent  content  comes  the  term  '*dream- 
making"  (Traumarbeit)  which  has  occasioned 
the  dream  distortion  (Traumentstellmig). 

If  one  proceeds  to  get  a  closer  view  of  the 
many-sided  and  peculiar  dream-making  process, 
one  is  at  once  struck  by  a  phenomenon  already 
recognized  externally.  The  dream  thoughts  dis- 
covered by  analysis  tremendously  exceed  in  ex- 
tent the  remembered  dream  content.  This  cir- 
cumstance points  to  a  great  condensation  of  the 
dream  thoughts.  Each  element  of  the  dream 
content  really  traces  its  source  not  to  a  single  ele- 
ment of  the  latent  dream  thoughts  but  to  a  series 
of  such  elements;  on  the  other  hand,  however,  it 
is  also  a  rule  that  a  dream  thought  may  be  repre- 
sented by  more  than  one  dream  element  in  the 
dream.  Thus,  the  threads,  of  association  do  not 
simply  converge  from  dream  thoughts  to  dream 
content  but  criss  cross  and  interweave  promis- 
cuously on  the  way.  In  this  condensation  proc- 
ess, certain  likenesses  which  originally  existed 
among  the  dream  thoughts  or  have  been  elabo- 
rated by  the  dream-making  in  a  very  keen  and  in- 
genious, witty  manner  play  the  greatest  role. 

Besides  the  condensation,  there  is  a  second 
process  suited  to  add  to  our  misunderstanding  of 
the  dream  picture  a  strangeness  concerning  the 
mental  value  of  the  same,  while  the  complete  in- 
terpretation shows  us  well-ordered  and  ingenious 


30£  FKEUD'S  THEORY  OF  THE  NEUROSES 

trains  of  thought  which  lie  at  the  bottom  of  the 
dream  in  their  proper  mental  accentuation;  al- 
most always  in  the  dream,  something  of  secondary- 
importance  and  insignificance  is  exhibited  with  a 
disproportionate  amoimt  of  affect.  This  dis- 
placement (Verschiebung)  of  the  mental  values 
from  important  to  insignificant  serves  mostly  to 
conceal  the  meaning  of  the  dream  and  to  render 
irrecognizable  the  connection  between  the  dream 
content  and  the  dream  thoughts.^ 

Besides  the  condensation  and  displacement,  the 
two  most  important  and  for  the  dream-making 
most  characteristic  processes,  the  attempt  to  pre- 
sent the  material  in  dramatic  form  (Riicksicht 
auf  Darstellbarkeit)  drives  the  dream,  at  first  in 
verbal  expression,  to  very  strange  performances 
in  order  that  the  dream  thoughts  may  be  pre- 
sented in  visible  form ;  to  this  aim,  manifold  dis- 
tortions and  modifications  must  be  brought  about. 

The  dream  thoughts  which  by  the  attempt  to 
present  them  in  dramatic  form  and  by  the  dream 
distortion  practiced  by  the  censor  have  become 
irrecognizable  and  incomprehensible  are  finally 
subjected  to  a  final  external  arrangement  which 
is  carried  out  more  or  less  carefully  in  different 

1  Condensation  and  displacement  find  expression  not  only  in 
thought-making,  but  also  in  the  dramatization  of  details.  Thus, 
objects,  words  and  persons  can  be  made  irrecognizable  by  combi- 
nation; a  person  at  first  apparently  imknown  to  the  dreamer  is 
regularly  a  composite  person. 


THE  DREAM  103 

dreams  to  give  the  dream  pictures  which  were 
originally  intelligible  but  have  become  meaning- 
less through  the  dream-making,  at  least  exter- 
nally the  appearance  of  sense  and  connection. 
This  procedure  of  the  dream-making  which 
Freud  has  called  "secondary  elaboration" 
("sekundare  Bearbeitung"),  which  really  repre- 
sents a  concession  to  conscious  thinking,  also 
serves  on  the  other  hand  to  further  the  aims  of 
the  censor,  since  conscious  attention,  which  in 
badly  elaborated  dreams  is  diverted  by  the  judg- 
ment: ^'foolish"  or  '^dreams  are  nonsense,"  in 
dreams  with  well-composed  facades  is  reassured 
by  this  superficial  meaning  whereby  a  penetration 
into  the  deeper  meaning  of  the  dream  is  avoided. 

The  next  most  important  fact  concerning 
dreams  after  the  wish  characteristic  is  the  basic 
principle  that  the  majority  of  dreams  of  adults 
deal  with  sexual  material  and  give  expression  to 
erotic  wishes.  It  is  obvious  that  one  can  form 
an  opinion  on  this  only  when  one  considers  not 
merely  the  manifest  content  but  understands  how 
to  penetrate  to  the  latent  dream  thoughts.  The 
explanation  of  the  ubiquity  of  sexual  erotic  ma- 
terial in  dreams  is  to  be  sought  in  the  fact  that  no 
other  instinct  has  undergone  so  much  suppression 
from  childhood  on,  as  the  sexual  instinct  in  its 
numerous  components.     Thus,  the  erotic  wish- 


104     FREUD'S  THEORY  OF  THE  NEUROSES 

fulfillment  forms  the  essential  content  of  the 
dream;  still,  it  has  never  occurred  to  Freud  to 
make  this  characteristic  of  the  dream  exclusive, 
as  is  best  shown  by  his  comprehensive  book  on 
dream  interpretation  where  justice  is  done  to 
selfish  and  ambitious  wishes. 

The  assertion  that  the  majority  of  the  dreams 
of  adults  betray  in  their  ultimate  analysis  a  sexual 
content  seems  at  first — just  like  the  wish-fulfill- 
ment theory — unproven,  since  the  wording  and 
pictures  of  the  dream,  aside  from  the  exquisite 
sexual  (pollution)  dreams,  seldom  deal  with  sex- 
ual scenes,  lascivious  allusions  and  the  like  but 
are  mostly  thrown  together  in  a  harmless,  often 
poetical  manner  from  nature,  family,  society, 
travels,  etc.,  forming  living  pictures'  correspond- 
ing to  the  real  family,  vocational  and  amusement 
life.  At  first  it  seems  arbitrary  to  wish  to  read 
out  of  this  boundless  picture  gallery  comprising 
the  whole  life  in  all  its  phases  a  single  definite 
tendency  which  would  serve  only  one  instinct. 
Since  we  are  dealing  with  an  instinct  of  which 
every  one  is  more  or  less  ashamed  and  which  he 
does  not  like  to  acknowledge  himself  too  much 
possessed  by,  it  was  this  part  of  the  dream  theory 
which  aroused  universal  surprise  and  contradic- 
tion. Nevertheless,  Freud  has  proven  that  the 
theme  of  sexuality  does  not  appear  undisguised 
in  dreams  but  is  represented  in  a  definite,  typical. 


THE  DREAM  105 

regularly  found  symbolic  manner  of  expression 
analogous  to  pantomime.^  To  a  layman,  who 
came  across  this  theory  for  the  first  time,  it  might 
seem  grossly  arbitrary  to  consider  quite  innocent 
and  apparently  accidental  pictures,  objects,  per- 
sons, activities,  plays  on  words,  etc.,  in  sexual  and 
shocking  sense.  But  he  who  has  learned  to  un- 
derstand the  speech  of  the  neurosis  released  from 
the  repression  will  be  easily  convinced  that  the 
dream  as  well  as  the  pantomime  of  the  neurosis 
can  not  disclose  its  real  meaning  undisguised. 
Where  the  manifest  content  of  the  dream  is  acci-f 
dently  harmless,  confused  or  indistinct  (which  is 
frequently  coupled  with  anxiety)  one  should  al-'  I .  wA- 
ways  suspect  behind  it  an  especially  abundant 
repression  of  something  valuable.  It  is  the  cen- 
sor which  compels  dreams  to  adopt  the  mystic 
language  of  symbolism  to  secure  the  possibility  of 
dramatization  of  sexual  material  in  dreams.  If 
one  has  convinced  himself  of  the  wide  use  of  sym- 
bolism for  the  dramatization  of  sexual  material 
in  dreams,  he  must  have  been  struck  by  the  ques- 
tion whether  or  not  many  of  these  symbols  appear 

2  In  a  dream  in  two  parts  of  a  healthy  person,  the  second  part 
of  which — an  undisguised  pollution-dream — disclosed  the  appar- 
ently harmless  symbolically  clothed  and  sublimated  introductory 
dream  as  grossly  sexual,  Rank  was  able  to  substantiate  the  funda- 
mental principles  of  the  Freudian  dream  theory  as  it  were  by 
the  dream  itself.  Compare  "Ein  Traum  der  sich  selbst  deutet," 
Jahrb.,  II,  2,  1910. 


106  FREUD'S  THEORY  OF  THE  NEUROSES 

like  the  characters  of  stenography  with  a  fixed 
meaning  for  all  cases.  In  this  connection,  it  is 
to  be  noticed  that  this  symbolism  belongs  not  only 
to  dreams  but  also  to  the  unconscious  folk  ideas 
and  is  found  as  completely  in  folk-lore,  myths, 
saga,^  sayings,  maxims  and  in  the  current  wit 
of  a  people  as  in  dreams.^  Among  the  symbols 
so  used  are  really  many  which  regularly  or  almost 
regularly  mean  the  same  thing;  upon  this,  in 
greatest  part,  the  general  understanding  and  far- 
reaching  activity  of  these  creations  of  the  folk- 
mind  depend.^  Still,  one  must  always  bear  in 
mind  the  possibility  that  occasionally  an  element 
in  the  dream  content  is  not  to  be  interpreted  sym- 
bolically but  in  its  real  sense;  in  other  cases,  the 
dreamer  may  claim  the  right  to  anything  possible 
out  of  special  remembered  material  as  an  indi- 
vidual sexual  symbol  which  is  not  generally  so 
employed.     Further,  the  customary  sexual  sym- 

3  Compare  Riklin,  "Wunscherfiillung  und  Symbolik  im 
Marchen."  Further,  Abraham,  "Traum  und  Mythus"  and  the 
works  cited  there  by  Kleinpaul  and  others;  also  Rank,  "Der 
Mythus  von  der  Geburt  des  Helden."  They  all  appear  in 
Schriften  z.  angew.  Seelenkunde, 

4  In  regard  to  the  skepticism  which  the  symbolic  interpretation 
encounters  from  so  many,  it  is  characteristic  that  the  same  men 
while  listening  to  the  cynical  tune  at  the  Kneipe  or  the  cabaret 
or  reading  the  humorous  paper  are  suddenly  sufficiently  disposed 
to  understand  sexual  symbolism! 

6  Symbolism  was  already  familiar  in  part  to  the  old  authors 
(Artemidorus)  and  also  to  the  newer  ones  (Schemer,  Volkelt 
and  others). 


THE  DREAM  107 

bols  are  not  in  every  case  limited  to  the  one  mean- 
ing. 

After  giving  these  limitations  and  precautions, 
Freud  introduces  a  series  of  typical  sexual  sym- 
bols: emperor  and  empress  (king  and  queen) 
usually  stand  for  the  parents  of  the  dreamer, 
prince  or  princess  for  the  dreamer  himself.  All 
long  objects  such  as  canes,  limbs  of  trees,  snakes, 
umbrellas  (because  when  put  up  they  resemble 
an  erection!)  indicate  the  penis.  A  frequent, 
not  readily  understood  symbol  of  the  same  is  the 
nail  file  (because  of  the  rubbing  and  scraping?). 
Small  boxes,  band-boxes,  caskets,  closets,  ovens, 
wagons  correspond  to  the  female  body.  Rooms  in 
dreams  are  mostly  ladies'  rooms,  the  representa- 
tion of  the  entrances  and  exits  will  not  be  misun- 
derstood in  this  connection.  The  dream  of  going 
through  a  series  of  rooms  is  a  brothel  or  harem 
dream.  Tables,  tables  that  are  set  and  boards 
are  likewise  women  probably  because  of  the  con- 
trast which  here  preserves  the  body  arches. 
Since  board  and  bed  make  the  marriage,  in 
dreams,  the  first  is  often  placed  for  the  last  and 
so  far  as  it  applies,  the  sexual  idea-complex  is 
transported  to  the  eating  complex.  All  compli- 
cated machines  and  apparatus  in  dreams  are  with 
great  probability  genitals,  in  the  describing  of 
which,  dream  symbolism  shows  itself  as  untiring 
as  wit-making.     Landscapes  often  signify  fe- 


108  FREUD'S  THEORY  OF  THE  NEUROSES 

male  genitals;  the  locality  "in  which  one  was  once 
before"  may  symbolize  the  mother's  genitals. 
Children  in  dreams  also  often  signify  the  genitals 
as  men  and  women  are  occasionally  disposed  to 
call  their  genitals  their  "little  one."  Stekel,  who 
has  devoted  himself  especially  to  tracing  out 
dream  symbolism,®  continues  further  that  left  and 
right  often  mean  wrong  and  "right"  or  are  then 
used  in  transferred  sense  for  sensuous  (sinnlich) 
and  moral  (sittlich),  normal  and  abnormal,  male 
and  female,  etc. ;  further,  that  death  and  thoughts 
of  death  in  dreams  are  often  to  be  taken  as  re- 
pressed counterparts  for  life  and  riotous  living. 
It  is  to  be  expected  that  the  scientific  proof  for 
the  wide  range  and  folk-psychological  basis  of 
symbolism  will  soon  be  fully  produced  by  mythol- 
ogists,  linguists  and  students  of  folk-lore^  and 
that  thus  its  paradox  will  be  lost.  He  who  does 
not  understand  the  language  of  dream  symbolism 
will  never  completely  interpret  a  dream  and  can 
never  carry  through  a  completely  successful 
psycho-analysis.  The  symbolism  is  the  first  and 
most  important  technical  aid  to  psycho-analytic 

»"Beitrage  zur  Traumdeutung"  {Jahrb.,  I,  page  458)  and  fur- 
ther in  the  discussion  of  the  "Angstzustande."  Interesting  data 
on  dream  symbolism  are  also  found  in  Maeder,  "Essai  d'inter- 
pretation  des  quelques  reves*'  (Archives  de  Psychologi;  1907, 
No.  24). 

7  Compare  "Anthropophyteia,"  ed.  by  F.  S.  Krauss,  Leipdc, 
Deut.  Ver.  Akgt, 


THE  DREAM  109 

dream  interpretation.  Therefore,  a  knowledge 
of  it  is  indispensable  to  the  psycho-analyst  be- 
cause this  symbolism,  so  widespread  in  the  liis- 
tory  of  races  and  forming  such  a  sure  postulate 
for  those  living  under  the  same  cultural  condi- 
tions, still  in  isolated  cases,  especially  in  neurotics, 
may  be  an  unconscious  one  and  therefore  brings 
no  associations  to  the  dreamer  when  he  relates  his 
dream.  It  is  the  task  of  the  analyst  to  bring  the 
same  into  use  and  just  where  an  element,  through 
the  absence  of  associations,  makes  itself  suspicious 
as  a  symbol.  Thorough  familiarity  with  sym- 
bolism enables  the  physician  to  disclose  the  deep- 
est strata  of  the  unconscious  dream  thoughts  with 
a  high  degree  of  certainty;  still,  the  discovery  of 
the  recent  experiences  and  the  di*eam  thoughts 
springing  from  actual  conflicts  can  only  be  ac- 
complished by  the  aid  of  free  associations.  In 
this  way  only  is  it  possible  to  arrange  the  special 
dream  in  its  proper  psychic  connection.  This 
particular  kind  of  analysis  brings  to  light  some 
material  which  is  not  unconscious  in  the  strict 
sense  of  the  word  but  may  be  called  fore-con- 
scious because  it  is  not  directly  inaccessible  to  con- 
sciousness but  rather  may  be  rendered  conscious 
without  any  especial  difficulty. 

Here,  the  technique  of  dream  interpretation 
does  not  proceed  from  symbolism  but  from  the 
particular  associations  and  spontaneous  connec- 


V 


110     FREUD'S  THEORY  OF  THE  NEUROSES 

tions  of  the  dreamer,  the  relation  of  which  to  the 
sought-for  thought  complex  may  be  proven  by 
the  already  mentioned  association  experiment. 
If  one  wishes  to  interpret  a  dream  according  to 
the  method  here  described,  it  is  best  to  analyze 
the  dream  elements  separately,  according  td  the 
dream  text  noted  down  from  the  fresh  remem- 
brance in  the  morning  without  any  attention  to 
its  eventual  external  connection  ( secondary  elabo- 
ration). If  one  devotes  himself  now  to  the  free 
associations  from  each  of  these  elements  taken  at 
random  out  of  its  context  of  ideas  and  memories, 
then  he  soon  succeeds  in  apprehending  a  lot  of 
ideas  and  memories  which  not  only  possess  an  in- 
ternal relationship  to  the  dream  content  but  also 
arrange  themselves  in  a  connected  and  intelligible 
whole.  The  associations,  whether  free  or  from 
test'  words,  are  distinguished  in  many  ways  by  a 
superficial  connection,  by  clang  association,  plays 
on  meanings  of  words,  temporal  conjunctions, 
inner  sense  relations,  in  short  by  all  the  associa- 
tion ways  which  we  are  accustomed  ^  to  observe 
in  wit  and  puns.     No  connection  is  too  loose,  no 

8  That  the  ancients  had  a  knowledge  of  such  mechanisms  which 
must  in  general  be  considered  as  forerunners  of  psychological 
dream  interpretation  is  shown  by  the  following  example:  Alex- 
ander while  despairing  of  the  capture  of  the  city  of  Tyre  which 
he  had  besieged  had  his  dream  of  a  Satyr  dancing  in  triumph  on 
a  shield  interpreted  by  the  dream-interpreter  as  being  good  for- 
tune since  cd  Tvpos  meant  your  Tyre  (Tyros)  (Artemidorus). 


/ 


THE  DREAM  111 

witticism  too  far-fetched  to  have  formed  the 
bridge  from  one  thought  to  another.     The  serious 
and  important  utihzation  of  these  associations  be- 
comes plausible,  however,  when  one  knows  that 
every  time  a  psychic  element  is  joined  to  another  j 
by  a  shocking  and  superficial  association,  a  cor-  i 
rect  and  deeper  attachment  exists  between  the  |  y/ 
two,  which  because  of  the  underlying  resistance  )  ^i^'^ 
of  the  censor  must  be  concealed  behind  that/ 
superficial  connection.     The  beginner  who  can 
hardly  make  up  his  mind  to  adopt  this  rule  will 
also  not  hear  without  resistance  that  occasionally 
a  part  of  a  dream  only  becomes  intelligible  after 
one  has  inverted^  individual  elements  either  in 
content  or  temporal  relationship.     The  inversion, 
change  to  the  contrary,  ^^  is  one  of  the  favorite 
means  of  dramatization  in  the  dream-making  and 
capable  of  manifold  application.     It  serves  first 
of  all  to  furnish  meaning  for  the  wish-fulfillment 
in  respect  to  a  definite  element.     "Would  that  it 
had  been  different"  is  often  the  best  expression 
for  the  relation  of  the  ego  concerning  a  painful 
bit  of  memory.     The  inversion  becomes  very 
valuable  in  the  service  of  the  censor  since  it  brings 
about  a  measure  of  distortion  of  the  material  be- 

oAs  a  linguistic  confirmation,  compare  Freud,  "tJber  den 
Gegensinn  der  Urworte,"  Lit.  No.  40. 

10  Compare  for  example  the  symbolic  dramatization  of  "secret" 
by  the  presence  of  many  persons  or  the  whole  family. 


112     FREUD'S  THEORY  OF  THE  NEUROSES 

ing  dramatized  which  immediately  interferes  with 
the  understanding  of  the  dream.  Therefore, 
when  a  dream  obstinately  refuses  to  yield  its 
meaning  to  interpretation,  one  may  every  time 
venture  to  try  the  inversion  of  the  special  parts 
of  its  manifest  content  and  often  all  becomes 
clear.  Besides  the  inversion  of  content,  the  in- 
version of  time  is  also  not  be  overlooked.  ^^ 
Whoever  wishes  to  take  up  the  scientific  interpre- 
tation of  dreams,  must  continually  study  the 
"Traumdeutung"  of  Freud's.  Here  can  be 
given  only  some  practical  hints  and  the  indis- 
pensable instructions.  For  example,  everything  ^ 
which  appears Jn  the  dream  at  all  striking,  as  ) 
spoken  language,  goes  back  to  real  language  of 
the  dreamer  or  to  speech  which  he  has  heard.^^  In 
this  regard,  the  analysis  reveals  that  the  dream 
combines  most  arbitrarily  mere  fragments  of 
these  real  speeches.  Another  means  of  the  cen- 
sor is  the  forgetting  of  the  dream  which  is  in  this 
manner  withdrawn  from  analysis.  At  the  be- 
ginning of  the  treatment,  this  happens  often  so 
completely  that  the  patient  in  general  brings  no 

11  The  same  technique  serves  many  times  to  conceal  the  meaning 
of  the  hysterical  attack.    Lit.  No.  33. 

12  Thus  far,  the  only  exception  to  this  empiric  rule  is  in  certain 
dreams  of  the  obsessed  which  may  bring  the  particular  text  of 
the  obsessional  command  in  the  form  of  spoken  language,  which 
text  is  known  to  them  in  waking  hours  only  as  confused  and 
distorted.    Lit.  No.  36, 


THE  DREAM  113 

dreams  and  also  aserts  that  he  dreamed  none.^^ 
In  weakened  form,  this  tendency  of  the  censor 
is  shown  in  the  forgetting  of  a  part  of  a  dream, 
which,  if  it  is  afterwards  remembered,  must  be 
appraised  very  highly;  it  is  easy  to  understan(f 
that  for  just  this  reason  it  would  be  kept  from 
the  work  of  interpretation  as  long  as  possible.  A 
kind  of  failed  forgetting  is  shown  in  isolated 
parts  of  a  dream  being  characterized  as  * 'con- 
fused or  unimportant."  These  parts  are  also  es- 
pecially important  and  will  usually  conceal  some- 
thing strikingly  surprising  and  shocking  from 
the  unconscious.  For  interpretation  work,  it  is 
important  to  remember  that  dreams  of  the  same 
night  or  now  and  then  even  of  a  series  of  nights 
have  a  close  relation  as  to  content  and  especially 
that  the  dreams  of  a  single  night  are  always  to 
be  considered  as  a  whole. 

In  dream  interpretation,  it  is  a  most  difficult 
thing  to  convince  a  beginner  that  his  task  is  not 
completely  performed  when  he  has  a  full  inter- 
pretation of  the  dream  in  his  hands,  one  which 
is  intelligible,  connected  and  gives  information 
concerning  all  the  elements  of  the  dream  content. 
There  may  be  possible  another  one  besides,  a  fur- 
ther interpretation  (over-interpretation)  of  the 
same  dream.     The  question  whether  every  dream 

13  Perhaps  the  "not  dreaming"  which  so  many  people  assert  is 
only  a  "not  paying  attention  to  the  dreams." 


114  FREUD'S  THEORY  OF  THE  NEUROSES 

can  be  interpreted  is  for  practical  purposes  to 
be  answered  in  the  negative.  It  should  not  be 
forgotten  that  in  dream  interpretation  one  has 
against  one  the  mental  forces  which  cause  the 
distortion  of  the  dream.  Thus  it  is  a  question 
of  relative  strength  whether  one  can  become  mas- 
ter of  the  inner  resistances.  Part  way  this  is 
always  possible,  at  least  so  far  as  to  gain  the  con- 
viction that  the  dream  is  an  intelligible  formation 
and  usually  also  to  gain  a  hint  of  its  meaning. 

Exactly  in  contrast  to  the  freedom  of  the  in- 
dividual to  elaborate  his  own  dream  world  in 
personal  strangeness  and  thereby  render  its  com- 
prehension unattainable  to  others,  there  are  a 
number  of  dreams  which  almost  every  one  has 
dreamed  in  the  same  fashion,  from  which  fact,  it 
can  be  assumed  that  they  have  the  same  signifi- 
cance for  every  one.  An  especial  interest  attaches 
to  these  "typical  dreams"  because  they  probably 
arise  from  the  same  sources  in  all  people,  thus 
seem  especially  well  suited  to  give  us  some  con- 
clusions concerning  dream  sources.  The  typical 
dreams  of  people  would  be  worthy  a  penetrating 
investigation;  Freud  in  his  work  only  takes  up 
in  detail  some  samples  of  this  class.  One  of  the 
most  widespread  dreams,  the  elucidation  of 
which  will  be  earliest  attainable  to  the  laiety,  is 
the  so-called  embarrassment  dream  of  nakedness, 
which  happens  also  with  the  addition  that  one 


THE  DREAM  115 

was  not  at  all  ashamed,  etc.  Our  interest  is  only- 
due  the  nakedness  dream,  however,  when  the 
dreamer  feels  shame  and  embarrassment  in  it 
and  wishes  to  fly  or  hide  himself;  in  that  lies  the 
peculiar  inhibition  that  one  cannot  move  from 
the  place  and  feels  powerless  to  change  the  pain- 
ful situation.  Only  in  this  connection  is  the 
dream  typical.  As  a  rule,  the  defect  in  the  toi- 
lette is  not  so  bad  as  to  make  the  shame  accom- 
panying it  seem,  justified.  Freud  has  learned  to 
consider  this  nakedness  dream  as  an  exhibitionist 
dream  and  traces  it  back  to  the  active  spontane- 
ous disrobing  of  children  which  gives  them  great 
pleasure  and  enjoyment.  Aside  from  this  repe- 
tition of  an  infantile  wish-fulfillment,  the  repres- 
sion also  comes  naturally  to  expression  in  the  ex- 
hibitionist dream;  the  painful  feeling  in  the 
dream  (shame,  etc.)  is  indeed  a  reaction  because 
the  since  abandoned  content  of  the  exhibition- 
istic  scene  has  therein  succeeded  in  coming  to 
representation. 

A  second  group  of  typical  dreams  which  is  es- 
pecially characteristic  and  important  for  the  neu- 
rosis and  the  family  conflict  underlying  it  has 
for  content  that  a  dear  relative  (parent,  brother, 
sister,  child,  etc.)  is  dead.  Also  in  these  dreams, 
only  those  are  typical  in  which  one  feels  deep 
grief  over  the  death.  According  to  Freud's  ex- 
planation,  these   dreams  signify  exactly  what 


116     FREUD'S  THEORY  OF  THE  NEUROSES 

their  content  says  according  to  the  fundamental 
principle  of  wish-f ulfillment :  namely,  the  wish 
that  the  person  in  question  really  was  dead. 
This  interpretation  will  probably  excite  a  priori 
indignant  denial  in  every  one.  Nevertheless,  one 
must  keep  in  mind  that  the  hostile  death  wish 
against  a  near  relative  need  not  be  an  actual  one. 
The  dream  theory  is  satisfied  in  the  conclusion 
that  the  dreamer  has  wished  the  death  sometime 
in  childhood;  this  wish  springs,  as  a  rule,  from 
the  childish  idea  of  life,  in  which  death  has  only 
the  significance  of  a  separation,  an  interruption 
of  the  disturbing  presence  of  a  person,  thus,  a 
kind  of  journey  without  return.^'* 

Among  these  dreams  of  the  death  of  dear  rela- 
tives, the  dream  of  male  individuals  of  the  death 
of  the  father  assumes  a  special  significance  since 
it  occurs  with  these  people  frequently  in  connec- 
tion or  alternating  with  the  dream  of  having 
sexual  intercourse  with  the  mother,  a  dream,  the 
typical  character  of  which  was  already  known 
to  the  ancients.  This  dream  shows,  therefore, 
the  sexual  wish-fulfillment  in  contrast  to  other 
dreams,  so  crass  and  undisguised  because  it  is  usu- 
ally a  pollution  dream.  Corresponding  to  this 
pair  of  dreams  of  male  individuals  is  an  analogous 
pair  with  changed  sexes  but  usually  in  veiled  form 

14  For  this  childish  idea  of  death  compare  Traumdeutung,  page 
180  and  "Analyse  der  Phobia  eines  funfjahrigen  Knaben," 


THE  DREAM  117 

occurring  in  the  female  sex.^^  This  group  of 
typical  dreams  betrays  that  ''GEdipus-complex" 
of  all  people  first  pointed  out  by  Freud  which 
has  found  its  artistic  expression  in  the  celebrated 
tragedy  of  Sophocles.  As  is  constantly  being 
more  plainly  shown,  this  complex  plays  the 
leading  part  in  the  childhood  mental  life  of  all 
individuals  who  later  become  psychoneurotics; 
love  for  one,  hate  for  the  other  of  the  parents  be- 
long to  the  fixed  condition  of  the  material  in 
psychic  impulses  formed  at  that  time  so  impor- 
tant for  the  symptomatology  of  the  later  neu- 
rosis. 

Recently  (in  the  second  edition  of  the  Traum- 
deutung) ,  Freud  has  treated  exhaustively  some 
other  typical  dreams.  Thus,  the  examination 
(proving)  dream  (maturity  dream)  which  be- 
longs to  the  most  frequent  of  typical  dreams. 
These  anxious  dreams  that  one  must  repeat  the 
final  examination  (eventually  a  rigorous  one)  or 
a  school  test  always  appear,  according  to  Stekel's 
explanation,  when  one  anticipates  next  day  a  re- 
sponsible task  and  the  possibility  of  a  disgrace 
which  relates  mostly  to  the  sexual  tests  (matura- 
mature,  potent) .  The  dream  is,  in  a  way,  a  con- 
solation, since  the  dreamer  says:  you  have  also 

15  The  disguised  forms  of  the  OEdipus  dream  are  as  frequent  as 
the  undisguised.  Also  this  dream  appears  in  hypocritical  repre- 
sentation which  treats  the  rival  tenderly. 


118     FREUD^S  THEORY  OF  THE  NEUROSES 

before  the  examination  Kad  anxiety  and  yet  it 
went  off  all  right ;  therefore,  nothing  will  happen 
to  you  this  time!  The  following  fact  affords 
proof  for  this  conception:  the  dream  is  only 
dreamed  by  persons  who  have  passed  that  exam- 
ination. 

At  the  bottom  of  a  great  number  of  dreams 
which  are  frequently  accompanied  by  anxiety, 
which  have  as  content  the  passing  from  narrow 
rooms  or  being  in  the  water,  lie  phantasies  of  the 
intrauterine  life,  the  stay  in  the  mother's  body 
and  the  birth  act;  one  succeeds  in  interpreting 
them  by  inverting  the  facts  detailed  in  the  dream, 
thus,  instead  of  falling  into  the  water,  to  come 
out  of  the  water,  i.  e,,  be  born.^^ 

Robbers,  nocturnal  burglars  and  ghosts,  of 
which  one  is  afraid  in  the  dark,  and  which  also  oc- 
casionally visit  the  sleeper  in  dreams,  are  some- 
times memories  of  the  nocturnal  visitors  who  have 
at  that  time  awakened  the  child  to  set  him  on  the 
chamber  that  he  might  not  wet  the  bed  or  to  pre- 
vent onanistic  acts.  (Concerning  the  robber- 
dreams  of  the  anxiety-neurosis,  compare  Chap- 
ter VI.) 

Fire-dreams  which  refer  mostly,  on  account  of 
the  association  with  ^'playing  with  fire,"  to  a  fre- 

16  Compare  the  proof  of  this  symbolism  as  an  universal  folk 
one  in  Rank,  "Der  Mythus  von  der  Geburt  des  Helden." 


THE  DREAM  119 

quent  eneuresis  ^^  are,  however,  usually  overde- 
termined  by  taking  fire  symbolically  as  standing 
for  passion. 

Of  the  typical  toothache-,  flying-  and  other 
dreams,  there  are  in  the  Traumdeutung  frequent 
explanations  which  facilitate  the  elucidation  of 
these  dream  pictures  that  are  often  so  distorted: 
toothache-dreams  apparently  correspond  regu- 
larly to  masturbation;  flying  means  sexual  in- 
tercourse.^^ 

If  the  dream  is  in  essentials  a  creation  of  the 
unconscious,  still  one  must  not  consider  it  as  a 
product  completely  uncontrolled  by  conscious- 
ness. Just  as  the  subject  of  hypnosis  has  more 
power  beyond  his  orders  than  one  commonly  sup- 
poses, so  the  dream  stands  under  a  certain  control 
of  conscious  judgment  which  is  betrayed  in  the 
often  radical  interference  of  the  psychic  censor. 
This  explains,  for  example,  how  a  dreamer  starts 
up  from  a  dream  at  the  right  time  to  note  the 
solution  of  a  problem,  the  answer  to  which  had 
been  sought  in  vain  by  day.  Thus,  one  under- 
stands the  consolatory  feeling  so  common  in 
dreams  that  it  is  all  a  di'eam  (dream  within  a 
dream,  Stekel). 

It  IS  obvious  that  the  presentation  given  here 

17  Lit  No.  21,  page  93. 

18  Compare  Lit.  No.  39,  page  59. 


120  FREUD'S  THEORY  OF  THE  NEUROSES 

cannot  be  a  complete  and  exhaustive  review  of 
the  comprehensive  work  on  dream  interpretation. 
Thus,  concerning  affects  in  dreams,  concerning 
absurd  dreams,  nothing  much  has  been  said;  this 
is  to  be  found  at  first  hand  in  Freud's  funda- 
mental work;  ^^  in  general,  a  close  study  of  this 
is  indispensable  for  the  scientific  appreciation  and 
application  of  dream  interpretation.  The  im- 
portance of  the  art  of  dream  interpretation  for 
the  psycho-analytic  treatment  of  psychoneurotics, 
Freud  has  shown  in  detail  in  his  "Bruchstiick 
einer  Hysterieanalyse"  where  two  dreams  of  a  pa- 
tient are  interpreted  and  synthetically  assembled 
and  utilized  psycho-analytically. 

19  An  English  edition  of  this  book  has  been  prepared  hj  Dr. 
A.  A.  Brill,  of  New  York,  and  published  by  MacmiUan  Co.,  of 
New  York,  and  Geo.  Allen,  of  London,  1912?. 


CHAPTER  VI 

HYSTERIA 

Freud's  Position  in  the  Study  of  Hysteria.  Repres- 
sion and  Conversion.  Sexuality  and  Infantilism.  The 
Hysterical  Mind.  The  Hysterical  Symptom:  its  So- 
matic and  Psychic  Foundations.  The  Hysterical  Phan- 
tasies. The  Hysterical  Attack.  Nervous  Disturb- 
ances. Neurotic  Anxiety  (Anxiety-Dream,  Anxiety- 
Hysteria,  Phobia).     Concerning  the  Psychoses. 

Since  the  "Studien  iiber  Hysterie'*  which 
Freud  published  in  collaboration  with  Breuer  in 
1895,  the  essential  features  of  which  were  re- 
viewed in  the  general  theory  of  the  neuroses,  he 
has  not  made  a  systematized  presentation  of  the 
insight  and  progress  since  gained  in  the  subject; 
hence  this  chapter  can  afford  no  systematic  and 
well-rounded  picture  but  only  a  cursory  view. 

The  psychogenic  nature  of  hysteria  which  had 
figured  as  a  disease  of  the  nerves  until  the  time  of 
Charcot  is  already  generally  recognized  from  the 
works  of  Janet,  Breuer  and  Freud.  Although 
the  French  school,  with  P.  Janet  at  its  head,  had 

already  accepted  the  conception  of  the  dissocia-   I  I  j 

121  *      ' 


I 


N* 


122     FREUD'S  THEORY  OF  THE  NEUROSES  s 

tion  of  mind  and  of  the  unconscious  in  hysteria,   | 
^       still  the  view  of  Janet  that  the  cause  of  the  estab-   | 
lishment  of  this  mental  dissociation  was  an  inborn  I 
weakness  of  the  mental  synthesis  was  an  unsatis-  J 
/y    \     factory  one.     The   Breuer-Freudian  view  put  y 
uX*^      this  dissociation  and  the  imconscious  in  their  cor- 
1^  i/).  \    rect  mutual  relationship  by  introducing  a  dy- 
namic conception:  the  mental  life  is  represented 
as  a  play  of  impelling  and  inhibiting  forces  and  if, 
in  one  case,  a  group  of  ideas  remain  in  the  uncon- 
'  I  scions,  an  active  conflict  with  other  groups  of 

tr^^^    I  ideas  has  caused  the  isolation  and  the  unconscious- 
^^r^  *'  ness  of  the  first  group.     Thus,  the  peculiarity  of 
the  Freudian  conception  lies  in  the  "repression." 
The  analysis  proves  that  such  repressions  play  an 
extraordinarily  important  role  in  our  mental  life, 
that  they  may  also  frequently  miscarry  in  the  in- 
dividual and  that  this  failure  of  the  repression 
is  the  prerequisite  of  the  symptom  formation. 
[     Psycho-analysis  has  not  only  enabled  us  in  this 
^"manner  to  formulate  the  theory  of  the  psychic 
conflict  and  the  repression  but  also  to  give  the 
answer  to  the  question,  whence  comes  such  a  re- 
pression compelling  strife  between  the  ego  and 
^^  individual  groups  of  ideas.     It  deals  with  that 

deep  antagonism  between  the  instincts  which 
serve  sexuality  and  the  gaining  of  sexual  pleas- 
ure and  those  other  instincts  which  have  as  a  goal 
the  constitution  of  the  personality,  the  ego-in- 


HYSTERIA  123 

stincts.  The  ego  feels  itself  threatened  by  the 
demands  of  the  overpowering  sexual  instinct  and 
seeks  to  protect  itself  by  repression.  Freud; 
could  show  further  that  the  ultimate  cause  of  the' 
neurosis  arose  in  early  childhood  where  the  in- 
stinctive life,  strengthened  under  certain  constitui 
tional  conditions/  favors  the  failure  of  the  represl 
sion.  The  hysterical  repression  finds  its  analogue 
respecting  its  prerequisite  condition,  as  has  al- 
ready been  pointed  out  under  sexuality  of  chil- 
dren, in  the  normally  appearing  **organic  repres- 
sion" of  the  child's  instinctive  and  sexual  life. 
This  repression  is  the  preliminary  condition  of 
that  later  hysterical  repression  which  is  only  com- 
prehensible through  the  circumstance  that  the  in- 
dividual already  possesses  a  store  of  memories 
which  are  withdrawn  from  conscious  disposition 
and  which  now  cut  the  bonds  of  association,  leav- 
ing them  free  from  consciousness  to  exercise  the 
shocking  powers  of  the  repression.  Thus,  the 
sexually  mature  neurotic  individual  brings  with 
him  regularly  some  sexual  repression  from  his 
childhood  which  comes  into  influence  in  the  de- 
mands of  real  life  and  leads  to  conflicts.  Thie 
flight  from  unsatisfying  reality  which  is  never 
without  an  immediate  gain  of  pleasure  for  the 
patients,  the  return  to  earlier  phases  of  the  sexual 

1  Compare  A.   Adler,   "uber  neurotische   Disposition,"   Jahrb., 
1*2. 


124      FREUD'S  THEORY  OF  THE  NEUROSE^ 

life  which  at  that  time  did  not  lack  a  certain  sat- 
isfaction, thus  as  it  were,  an  infantile  condition 
of  the  sexual  Hf  e  is  reestablished. 

Only  through  the  disclosure  of  the  fundamental 
etiological  importance  of  the  psycho-sexual  de- 
velopment for  the  establishment  of  the  neuroses 
has  hysteria  ceased  to  be  a  "child  of  sorrow"  of 
medical  science  for  all  earlier  theories  have  led  to 
no  solution  or  to  an  only  partiallj^  satisfactory  in- 
terpretation and  explanation  of  this  strange  dis- 
ease. Freud  has  both  lifted  the  veil  from  the 
hysterical  mental  condition  and  also  shown  the 
abundant  and  widely  ramifying  psychic  deter- 
mination of  the  symptom.  He  has  uncovered  the 
motives  and  the  content  of  the  hysterical  symp- 
toms and  of  the  attack  as  well  as  the  phantasies 
lying  at  the  bottom  of  them.  As  you  might  say, 
Freud  has  brought  method  out  of  madness.  His 
results,  in  this  his  particular  field  of  investiga- 
tion, have  not  sprung  from  speculation  but  from 
pure  empiricism  and  could  not  have  been  found 
earlier  by  any  other  way  than  that  of  psycho- 
analysis. On  the  contrary,  Freud's  investiga- 
tions have  not  dealt  essentially  with  that  part  of 
hysteria  which  the  medicine  of  the  schools  sees  in 
hysteria  and  considers  as  important  for  diagnosis, 
namely,  the  stigmata.  Freud  has  always  consid- 
ered the  pathological  phenomena  of  hysteria  from 
their  psychogenesis  and  it  is  in  just  this  field  that 


HYSTERIAS  125 

psycho-analysis  gaining  its  popular  value  as 
therapy  has  shown  its  ideal  value  for  investiga- 
tion most  splendidly.  If  in  such  a  penetrating 
presentation  of  the  mental  processes,  the  clinical 
histories  of  hystericals  read  like  novels,  it  lies  in 
the  nature  of  the  object,  in  the  internal  relation- 
ship between  the  story  of  suffering  and  the  dis- 
ease symptom  to  which  physicians  must  accustom 
themselves. 

Strange  ideas  concerning  the  pathological 
changes  in  the  genital  sphere  which  might  consti- 
tute the  starting  point  for  hysterical  troubles 
were  held  by  the  ancient  Greeks  and  Romans. 
These  basic  thoughts  have  been  accepted  in  modi- 
fied form  in  the  last  decades  by  a  number  of 
scholars.  Freud  has  taken  all  these  indistinct 
presentiments  of  the  mystics  and  although  he 
cannot  avoid  admitting  that  somatic  disturbances 
of  the  elaboration  of  the  sexual  material  in  the 
ultimate  analysis  lie  at  the  bottom  of  these  phe- 
nomena,^ still  he  has  shown  the  predominant  part 
of  psycho-sexuality  in  the  pathogenesis  of  hys: 
teria  in  widest  measure.  The  chief  content  of 
the  mental  structure  of  hystericals  is,  according 
to  the  results  of  psycho-analytic  investigations, 

2  If  the  reproach  should  be  made  against  the  Freudian  theory 
that  as  a  purely  psychological  conception  it  is  unable  to  solve  a 
pathological  problem,  the  same  is  not  justified.  No  one  can  deny 
the  sexual  function  in  the  special  relations  of  which  Freud  sees 
the  essence  of  hysteria,  the  characteristic  of  an  organic  factor. 


ff^^ 


126     FREUD'S  THEORY  OF  THE  NEUROSES 

formed  by  the  ''love-life"  in  its  broadest  sense, 
together  with  its  intensive  phantasies.     Whoever 
is  skeptical  on  this  point  nowadays  plays  a  role 
scarcely  tenable  since  the  association  investigation 
has  provided  exact  proof  for  the  fact  that  such 
emotionally  toned  erotic  complexes  rule  the  men- 
tal picture  of  hystericals.     This  chief  content  of 
the  mental  picture  of  hystericals  is  really  often 
hidden    from    superficial    observation    or    sym- 
boHcally  represented  hke  sexual  matter  in  the 
;  dream.     Nevertheless,  the  hysterical  mind  is  con- 
trolled from  childhood  on  by  powerful  counter- 
^r^"^' j[  impulses  against  their  abnormally  strong  instinc- 
^£i^-^f  tive  impulses.     Only  he  who  knows  the  romance 
,,fvd  "L  of  the  hysterical  can  also  bring  the  comprehension 
of  the  striking  character  changes  which  stand  in 
closest  connection  to  the  fate  of  his  eroticism. 
>   ^         The  general  picture  of  hysteria  is  further  only 
j»4cw^    comprehensible  when  one  has  recognized  that  the 
jc>-|*^  hysterical  fulfills  an  imconscious  wish  with  his 
-^r. ^  1^  malady  which  should  exempt  him  from  the  solu- 
^y^       tion  of  his  momentous  erotic  conflict.     On  this 
S  ^  ^^<  point,  there  is  a  certain  external  similarity  be- 
^Ti  ^  tween  Freud's  conception  and  the  common  view 
?^         to  the  extent  that  a  recent  experience  makes  the 
latent  hysterical  notoriously  ill.     Later  investi- 
gation, however,  shows  these  recent  experiences 
to  be  regularly  conflicts  of  the  eroticism  (a  disap- 
pointment in  love,  a  compulsory  or  renoimced 


HYSTERIA  127 

engagement,  a  sexual  assault,  a  sudden  sexual 
enlightenment),  and  when  to  superficial  observa- 
tion, there  seem  to  be  other  motives  (nursing  the 
sick,  death  of  a  relative,  etc. ) ,  a  more  penetrating 
investigation  regularly  reveals  unconscious  at- 
tachments between  these  banal  events  and  sexual      y 
and  infantile  impressions.     Thus,  the  hysterical!  ^rt;_^ 
patients  suffer  from  reminiscences.     The  ^^SL-b^j^JjM 
tion  of  certain  mental  impressions — Freud  speaks     .p\j:r^ 
of  an  heightened  irritability  or  tendency  to  fixa-      .  v^^^ 
tion  for  these  impressions — is  one  of  the  most  im-      ;^^  ^ 
portant  and  practically  significant  characteristics 
of  the  neurosis.     The  reaction  to  the  recent  expe- 
riences seems  inappropriate  when  one  does  not 
take  into  consideration  as  motives  the  real  remi- 
niscences in  the  unconscious.     Thus  are  explained 
the  overpowering  or  exclusive  reactions  to  sexual 
excitations  with  feelings  of  discomfort  in  which 
Freud  sees  a  sure  sign  of  hysteria  whether  the 
person  shows  a  somatic  symptom  or  not.     Doubt- 
less this  peculiarity  has  the  closest  relationship  as 
to  content  with  the  previously  mentioned  abnor- 
mal constitutional  forces  of  instinct  and  the  com- 
bative tendencies  of  these  and  further  an  historical 
connection  with  the  earlier  repressions. 

Further,  the  hysterical  traits  of  being  suggest-  \^]X^^^ 
ible  and  easily  hypnotized  seem  to  have  found  |      ^^^ 
the    hitherto    lacking    explanation    in    psycho-    ^^"^  ^^  * 
analysis.    Freud  believes   that  the  essence  of-^ -^  ^^J 


128     FREUD'S  THEORY  OF  THE  NEUROSES 

hypnosis  is  to  be  found  in  the  unconscious 
hbidinous  fixation  on  the  person  of  the  hypno- 
tizer  and  Ferenczi,  in  his  study,  "Introjektion 
und  Ubertragung"  (Jahrb.  I),  has  sought  the 
proof  of  this  phenomenon  at  the  bottom  of  the 
**parent  complex." 

If  this  pecuhar  nature  of  hystericals  may  thus 
be  understood  as  coming  from  a  special  psycho- 
sexual  basis,  the  origin  of  the  mysterious  symp- 
toms of  hysteria  must  be  correspondingly  eluci- 
dated. The  theory  of  the  pathogenesis  of  the 
hysterical  symptoms  forms,  as  we  have  cursorily 
shown  in  the  history  of  the  development  of  the 
Freudian  theory  of  the  neuroses  (Chapter  II), 
the  starting  point  for  Freud's  investigation  of  the 
psychoneuroses.  The  discovery  which  Breuer 
made  in  that  peculiar  case  of  hysteria  that  some- 
what analogously  to  the  traumatic  hysteria,  the 
ordinary  hysteria  owes  its  symptoms  to  dream- 
like mental  impressions,  was  the  starting  point  of 
the  theory  of  hysteria  later  elaborated  by  Freud. 
The  sexual  traumatic  experiences,  since  the  ideas 
which  accompanied  these  had  powerful  affects 
U^  (sum  of  excitation)  which  had  not  been  abreacted 
by  the  normal  reaction  of  communication  and  the 
corresponding  expression  of  emotion,  might  be- 
V  *^''\.  come  the  cause  of  hysterical  symptoms  when  this 
•^ '  accompanying  affect,  separated  from  the  unbear- 
^4*-^    able  idea,  was  applied  to  the  formation  of  a  phys- 


HYSTERIA  129 

ical  symptom.^  In  part,  these  "pent-up"  affects 
remain  as  lasting  burdens  of  the  mental  life  and 
sources  of  constant  excitation  to  the  same;  in 
part,  they  accomplish  a  transformation  into  un- 
common physical  innervations  and  inhibitions 
which  manifest  themselves  as  the  physical  symp- 
toms of  the  case.  Breuer  and  Freud  coined  for 
the  last  process  the  name  "conversion."  For  the 
comprehension  of  this  term,  the  reference  to  the 
"expression  of  the  emotions"  which  normally  be- 
trays our  mental  excitement  is  of  service ;  this  the 
hysterical  conversion  exaggerates  as  well  as  leads  7^) 

into   collateral   channels.     The   psycho-physical  p:^^^^^ 
tendency  to  conversion  represents  a  part  of  the     c^ljs^ 
hysterical   disposition.     Though   the  nature   of     >4.a^i 
conversion,  the  transformation  of  psychic  excita-    4^    c^ 
tion  into  physical  innervation  is  still  a  problem, 
Freud  has,  nevertheless,  through  his  recent  in-     ^^^/^ 
vestigation  been  able  to  make  important  con-        ^ 
tributions  concerning  the  direction  which  the  con- 
version takes  in  individual  cases,  now  causing  the 
paralysis  of  some  particular  part  of  the  body, 
again  an  hysterical  cough  or  vomiting,  etc.*     If 
his  discoveries  in  the  psychological  relations  and 
determinations  to  be  discussed  later  is  to  be  con- 

8  Experience  shows  that  the  conversion  does  not  follow  imme- 
diately the  causative  event  but  that  a  long  interval  may  intervene 
before  the  establishment  of  the  symptom. 

4  Concerning  conversion  into  anxiety,  compare  "anxiety 
hysteria"  in  latter  part  of  this  chapter. 


130  FREUD'S  THEORY  OF  THE  NEUROSES 

sidered  as  Freud's  greatest  work,  still,  he  has 
never  failed  to  emphasize  distinctly  that  every 
hysterical  symptom  has  not  only  a  psychic  origin 
but  also  a  somatic  basis  and  can  only  come  to  ex- 
pression when  a  certain  somatic  "preparedness" 
("somatisches  Entegegenkommen")  is  at  hand; 
this  is  provided  by  a  normal  or  pathological  proc- 
ess in  or  on  an  organ  of  the  body.  This  somatic 
preparedness  consists  of  numerous  conditions: 
first  is  the  way  already  prepared  by  physical  con- 
ditions of  irritation  of  these  organs,  for  example, 
the  establishment  of  an  hysterical  cough  from  an 
acute  catarrh.  A  much  more  important  condi- 
tion of  somatic  preparedness  is  when  the  affected 
organ  represents  an  erogenous  zone.  In  this 
connection,  Freud  has  pointed  out  that  just  as  in 
children  the  erogenous  peculiarity  can  be  moved 
to  any  favorite  body  zone  so  an  analogous  mova- 
bility  returns  in  the  symptomatology  of  hysteria.^ 
In  this  neurosis,  the  repression  concerns  the 
actual  genitals  for  the  most  part ;  these  give  their 
irritability  to  the  other  zones  which  ordinarily 
possess  little  such  function  and  these  latter  then 
behave  exactly  like  genitals.  Thus  for  example, 
an  hysterical  vomiting  might  arise  in  an  indi- 

6  With  the  typical  symptoms,  the  so-called  stigmata,  formerly 
greatly  overvalued  as  signs  of  hysteria,  Freud  has  not  dealt  closer 
than  occasionally  to  point  out  that  the  movability  of  the  ero- 
genous zones  has  also  here  the  greatest  significance:  erogenous 
and  hysterogenous  zones  show  the  same  characteristics. 


HYSTERIA  ISl 

vidual  for  whom  the  mouth  zone  was  preemi- 
nently emphasized  in  childhood  and  yielded  a 
pleasure  (sucking) ;  the  later  repression  of  this 
pleasurable  sucking,  because  of  the  close  connec- 
tion of  the  mouth  zone  with  the  instinct  of  hunger, 
might  encroach  on  the  latter.  All  of  Freud's  pa- 
tients with  disturbances  of  eating,  hysterical 
globus,  snoring  in  the  throat  and  vomiting  had 
been  energetic  suckers  in  childhood.  In  this 
fashion,  all  hysterical  abulias  come  about,  since 
the  organs  or  systems  of  organs  which  serve  these 
two  instincts  when  they  deny  the  erogenous  func- 
tion also  refuse  to  serve  in  their  other  function. 
Thus  arises,  for  example,  an  hysterical  disturb- 
ance of  the  gait  (abasia)  if  the  motor  movement 
in  a  phase  of  childhood  had  received  strong 
erogenous  emphasis  which  later  became  re- 
pressed.^ That  the  disturbance  can  turn  to  dif- 
ferent organs  rests  on  the  fact  that  corresponding 
to  the  component  instincts  and  the  perversions 
connected  with  them,  besides  their  regular  organic 
functions,  these  organs  also  serve  in  childhood  the 
most  diverse  erogenous  functions.  The  mouth 
serves  for  kissing  as  well  as  for  eating  and  the 
speech  function  (hysterical  vomiting,  mutism) ; 
the  eyes  receive  stimuli  in  order  to  perceive  not 
only  the  changes  in  the  external  world  important 
for  the  preservation  of  life  but  also  the  peculiari- 

« Compare  also  the  agoraphobia  later  in  chapter. 


132     FREUD'S  THEORY  OF  THE  NEUROSES 

ties  of  objects  by  which  these  are  raised  to  objects 
to  be  loved  (hysterical  disturbances  of  vision) . 

According  to  Freud,  for  the  establishment  of 
an  hysterical  symptom,  the  displacement  of  sex- 
ual feeling  also  plays  a  role.  Thus,  nausea  may 
'  arise  in  a  girl  who  perceives  a  genital  sensation 
on  the  occasion  of  a  kiss;  by  displacement,  this 
sensation  is  perceived  as  a  feeling  of  discomfort 
in  the  mouth  and  digestive  zone.  The  same  girl 
/  suffers  from  an  hysterical  pain  in  the  breast  since, 

during  an  embrace,  she  felt  the  pressure  of  an 
erect  penis  against  her  thigh.  Thus,  here  we 
have  to  deal  with  the  displacement  to  the  breast 
of  a  tactile  impression  on  the  thigh  converted  into 
an  hysterical  pain. 

More  important  than  the  reference  to  the 
somatic  conditions  of  the  symptom  and  Freud's 
particular  masterpiece,  is  the  discovery  of  the 

'  jl  symptom's  psychic  roots.     The  psychic  deter- 

minations are  not  simple  but  most  complicated. 

,jf  Determination  plays  an  important  role  through 

a  comprehensive  and  widespread  symbolism 
analogous  to  that  of  dream  life.  Thus,  for  ex- 
ample, in  a  female  patient,  the  unconscious  phan- 
tasy of  the  erect  male  organ  may  serve  as  model 
for  a  stiff  arm;  at  the  same  time,  however,  this 
symptom  was  the  punishment  for  an  intended 
sexual  aggression  with  the  hand.  As  a  rule,  the 
hysterical  symptom  does  not  have  merely  a  single 


HYSTERIA  133 

meaning  but  several  meanings  at  the  same  time 
(overdetermination) ;  these,  it  does  not  possess 
from  the  beginning  but  rather  gains  from  the 
thoughts  striving  to  find  expression.  Since  the 
origination  of  a  symptom  is  difficult  and  joined 
to  a  series  of  favoring  somatic  conditions,  it  is  evi- 
dent that  an  hysterical  symptom,  once  formed,  is 
retained  to  give  alternate  expression  to  diverse 
meanings. 

Just  as  certain  presuppositions  are  necessary 
for  the  establishment  of  the  symptom,  so  later 
circumstances  appear  in  this  connection  which  at 
the  beginning  of  the  malady  were  not  present  and 
had  no  share  in  the  symptom  formation;  only 
upon  the  later  appearance  of  these  is  the  disease 
fully  established:  these  circumstances  are  the  mo- 
tives for  the  malady.  Wherever  a  train  of 
thought  finds  it  convenient  to  use  a  symptom,  this  ui 
becomes  a  secondary  function  and  appears  fixed 
in  the  mental  life.  The  purpose  of  the  disease  is 
often  to  gain  affection,  indulgence  or  other  ad- 
vantage from  the  surroundings ;  frequently  a  de- 
sire for  revenge  is  one  of  the  strongest  uncon- 
scious motives  for  the  further  establishment  of  the 
symptom  and  naturally  a  great  hindrance  to  the 
treatment.  Nevertheless,  there  are  also  cases 
with  purely  internal  motives  such  as,  for  example, 
self-punishment,  repentance  and  penitence. 

According  to  the  original  view,  it  was  only  the 


QkiXJ' 


134     FREUD'S  THEORY  OF  THE  NEUROSES 

sexual  traumatic  experiences  which  by  their  in- 
tensity and  unbearableness  gave  occasion  to  the 
repression;  deeper  psycho-analytic  investigation 
has  disclosed  the  fact  that  it  is  much  more  the 
phantasies  (inventions  of  memory)  of  the  pa- 
tients, intensively  elaborated  mostly  in  the  years 
around  puberty  which  interpose  themselves  be- 
tween the  infantile  processes  and  the  symptoms, 
the  content  of  which  can,  under  certain  condi- 
tions, join  the  infantile  repression  of  instinct  and 
be  withdrawn  into  the  unconscious.  So  long  as 
these  phantasies  are  conscious,  we  call  them  day- 
dreams ;  their  possibility  for  being  repressed,  their 
becoming  unconscious  rests  on  their  close  rela- 
tion to  the  sexual  life  of  the  persons  in  question. 
The  phantasy,  after  it  has  become  unconscious,  is 
really  identical  with  the  (conscious)  phantasy 
which  the  person  has  indulged  in  for  sexual 
gratification  during  a  period  of  masturbation. 
The  act  of  masturbation  (in  widest  sense,  i.  e,, 
onanistic  act)  is  composed  at  that  time  of  two 
parts,  the  production  of  the  phantasy  and  the 
active  performance  of  the  self-gratification. 
This  combination  displays,  however,  a  line  of 
cleavage :  originally  the  action  was  a  purely  auto- 
erotic  attempt  to  gain  pleasure  from  a  definite 
erogenous  zone.  Later  this  action  blended  with 
the  wish  idea  from  the  circle  of  lovable  objects 
and  served  as  a  partial  reaUzation  of  the  situation 


HYSTERIA  135 

to  which  this  phantasy  pointed.  If  then,  the  per- 
son renounced  this  kind  of  masturbation-phan- 
tasy-gratification, the  action  would  be  stopped 
but  the  phantasy  would  pass  from  a  conscious  to 
an  unconscious  one.  If  no  other  kind  of  sexual 
gratification  took  its  place,  the  person  remained 
in  abstinence  and  was  unable  to  sublimate  his 
libido,  that  is,  divert  the  sexual  excitation  to 
higher  aims,  the  condition  was  just  right  for  the 
unconscious  phantasy  to  come  to  life,  grow  luxu- 
riantly and  constitute  itself  with  the  whole  force 
of  the  sexual  appetite  at  least  in  one  part  of  its 
content  as  a  disease  symptom.  For  a  whole  series 
of  hysterical  symptoms,  unconscious  phantasies 
of  this  kind  are  the  nearest  psychic  prototypes. 
The  hysterical  symptoms  are  nothing  else  than 
unconscious  phantasies  brought  to  representation 
through  conversion  and  in  so  far  as  they  are 
somatic  symptoms  they  were  often  enough  bor- 
rowed from  the  circle  pf  real  sexual  feelings  and 
motor  innervations  which  originally  accompanied 
them  when  they  were  still  conscious  phantasies. 
In  this  way,  the  giving  up  of  onanism  becomes 
really  retrograde  and  thereby  the  final  ultimate 
aim  of  the  whole  pathological  process,  the  recov- 
ery of  the  sexual  gratification  at  that  time 
primary,  is  never  attained  but  always  approxi- 
mated. The  interest  of  the  student  of  hysteria 
soon  turns  from  the  symptoms  themselves  to  the 


136     FREUD'S  THEORY  OF  THE  NEUROSES 

)         ^    phantasies  from  which  these  were  first  derived. 

j^^.  I  The  psycho-analytic  method  has  made  it  possible 
to  investigate  these  ultimate  unconscious  disease- 
producing  phantasies  of  people  and  in  Freud's 
analysis  of  a  child  neurosis  (see  Lit.  No.  35)  these 
could  be  directly  pointed  out  in  statu  nascendi. 
In  this  analysis,  it  was  revealed  that  these  phan- 
tasies which  intensively  occupy  the  dreamy,  neu- 
rotically predisposed  child  choose  for  their  ob- 
jects at  first  the  parents  and  the  immediate  sur- 
roundings of  the  child,  that  in  this  connection, 
pregnancy-  and  birth-phantasies  as  well  as  infan- 
tile sexual  theories  '^  which  the  unenlightened  child 
elaborates  for  the  explanation  of  these  mysterious 
processes,  play  an  important  role.  Since  at  this 
time  the  activity  of  the  normal  sexual  zone  does 
not  yet  stand  in  the  foreground,  the  child  being 
thus  still  polymorphous-perverse,  these  phan- 
tasies serve  the  most  diverse  erotic  desires  and  as 
the  difference  in  sex  is  still  also  a  problem  for  the 
child,  these  phantasies  are  also  bisexual.  The 
fact  that  in  general  the  same  phantasies  concern- 
ing childhood  are  always  formed  without  regard 
to  how  much  or  how  little  actual  material  real 
life  has  added  to  them,  is  explained  by  the  uni- 
formity of  the  child's  sexual  life  and  the  later 
modifying  influences.^ 

7  Lit.  No.  39. 

8  In  individuals  especially  constituted  by  their  heredity,  hysteria 


HYSTERIA  137 

Psycho-analytic  investigations  of  neurotics 
plainly  reveal  the  fact  that  the  growing  indi- 
vidual seeks  to  efface  in  his  phantasy-formations 
concerning  his  earliest  childhood  the  memory  of 
his  autoerotic  activity,  at  the  same  time  raising 
his  reminiscences  to  the  stage  of  love-of-an-ob- 
ject.  Hence,  the  superabundance  of  seductions 
and  outrages  in  these  phantasies,  where  often 
enough  the  reality  is  limited  to  autoerotic  activ- 
ity,^ a  distinction  which  in  forensic  cases  must  oc- 
casion the  judge  the  greatest  difficulties.  The 
correct  distinction  between  the  phantasies,  after- 
wards sexualized,  and  the  actual,  as  a  rule  banal 
events  of  childhood,  is  rendered  very  difficult  by 
the  fact  that  in  the  neurosis,  thought-reality  and 
not  actual  reality  has  value. 

Freud  has  enunciated  ^^  a  series  of  formulae 
which  attempt  to  treat  exhaustively  and  progres- 
sively the  nature  of  the  hysterical  symptom. 
These  do  not  contradict  one  another  but  corre- 

may  break  out  in  childhood  from  these  conditions,  usually  in  the 
form  of  anxiety-hysteria. 

9  It  must  be  constantly  borne  in  mind  that  the  hystericals  are 
inclined  in  their  phantasy-life  to  produce  injurious  dreams  and 
to  conceal  them  because  of  the  accompanying  pleasure  gained. 
Abraham,  "Das  Erleiden  infantiler  Sexualtraumen  als  Form  der 
infantilen  Sexualbetatigung,"  Zentralblatt  f.  Nervenh.  li.  Psych., 
1907.  A  series  of  dreams  coming  to  light  in  the  analysis  may, 
nevertheless,  be  traced  back  to  a  later  phantastic  elaboration  of 
aptoerotic  sexual  experiences.    Jdhrh.,  I,  page  393. 

loLitNo.  28. 


138     FREUD'S  THEORY  OF  THE  NEUROSES 

spond  in  part  to  more  complete  and  sharper  de- 
lineations, in  part  to  the  use  of  different  points  of 
view: 

1.  The  hysterical  symptom  is  the  memory-sym- 
bol of  certain  actual  (traumatic)  impressions  and 
experiences. 

2.  The  hysterical  symptom  is  the  substitute 
created  by  conversion  for  the  associative  return 
of  these  traumatic  experiences. 

^,  The  hysterical  symptom  is — like  otKer  psy- 
chic formations — the  expression  of  a  wish- fulfill- 
ment. 

4.  The  hysterical  symptom  is  the  realization  of 
an  imconscious  phantasy  which  serves  the  wish- 
fulfillment. 

5.  The  hysterical  symptom  serves  the  end  of 
sexual  gratification  and  represents  a  part  of  the 
sexual  hfe  of  the  person  (corresponding  to  one 
of  the  components  of  his  sexual  instinct) . 

6.  The  hysterical  symptom  corresponds  to  the 
return  to  a  kind  of  sexual  gratification  which  was 
real  in  infantile  life  but  has  since  been  repressed. 

7.  The  hysterical  symptom  arises  from  a  com- 
promise between  two  opposed  affective  and  in- 
stinctive impulses  by  which  the  one  brings  a  par- 
tial instinct  or  component  of  the  sexual  constitu- 
tion to  expression,  the  other  seeks  to  suppress  the 
same. 

8.  The  hysterical  symptom  can  become  the 


HYSTERIA  1S9 

representative  of  different  unconscious  non- 
sexual impulses  but  cannot  be  without  a  sexual 
meaning. 

Among  these  definitions,  it  is  the  seventh  which 
most  exhaustively  expresses  the  nature  of  the 
hysterical  symptom,  as  realization  of  an  uncon- 
scious phantasy.  When  one  in  this  manner,  by 
means  of  psycho-analysis,  succeeds  in  recogniz- 
ing the  component  of  the  sexual  instinct  which  is 
controlHng  the  individual,  one  comes  upon  the 
unexpected  discovery  that  for  many  symptoms 
the  solution  by  the  original  unconscious  sexual 
phantasy  is  not  sufficient,  but  that  one  needs  for 
the  solution  of  the  symptom  two  sexual  phan- 
tasies, of  which  one  has  a  masculine  character,  the 
other  a  feminine,  so  that  one  of  these  phantasies 
arises  from  an  homosexual  impulse.     Thus, 

9.  An  hysterical  symptom  is  the  expression,  on 
the  one  hand  of  a  masculine,  on  the  other  hand, 
of  a  feminine  unconscious  sexual  phantasy. 

Freud  believes,  however,  that  no  universal  ap- 
plication can  be  made  of  this  occurrence  of  two 
opposite  sexual  tendencies  in  one  symptom  as  in 
the  other  formulae,  important  though  it  is  theoret- 
ically and  also  not  to  be  underestimated  in  prac- 
tice. A  counterpart  of  this  hermaphrodism  of 
the  hysterical  symptom  is  shown  by  certain  hys- 
terical attacks  in  which  the  patient  plays  both 
roles  at  the  same  time  in  the  underlying  sexual 


140     FREUD'S  THEORY  OF  THE  NEUROSES 

phantasy.  This  contradictory  synchronism  con- 
ditions in  large  j)art  the  incomprehensibihty  of 
the  situation  otherwise  so  plastically  represented 
in  the  attack  and  is  thus  suited  for  disguising  the 
actual  unconscious  phantasy. 

Freud  has  really  shown  that  the  attack/^  this 
most  imposing  symptom  of  hysteria,  is  also  noth- 
ing else  than  a  phantasy  translated  into  motor 
phenomena,  projected  into  motor  activity,  repre- 
sented in  pantomime  and  that  by  witnessing  this, 
it  is  possible  to  recognize  the  phantasy  dramatized 
in  the  attack;  this  procedure  alone  succeeds  only 
rarely.  As  a  rule,  the  pantomimic  representa- 
tion of  the  phantasy  has  undergone  under  the  in- 
fluence of  the  censor,  distortions  quite  analogous 
to  the  hallucinatory  ones  of  the  dream,  so  that 
both  alike  have  become  incomprehensible  for  the 
patient's  consciousness  and  for  that  of  the  ob- 
server as  well.  The  hysterical  attack  may  thus 
undergo  the  same  important  elaboration  that  we 
see  in  nocturnal  dreams.  Thereby,  one  is  easily 
convinced  that  not  only  the  forces  from  which 
the  distortion  proceeds  and  the  purpose  of  this 
distortion  are  the  same  but  also  the  technique  is 
the  same  as  that  which  we  have  recognized  in  the 
interpretation  of  dreams. 

The  hysterical  attack  is  rendered  incompre- 
hensible, indistinct,  distorted  and  misleading: 

11  Lit  No.  33. 


HYSTERIA  141 

1.  By  condensation  of  several  simultaneous 
phantasies,  for  example,  a  recent  wish  and  the  re- 
vival of  an  infantile  impression. 

2.  By  multiple  identification  when  the  patient 
undertakes  to  carry  out  the  activities  of  both  per- 
sons appearing  in  the  phantasy. 

3.  By  the  antagonistic  conversion  of  the  inner- 
vation which  is  analogous  to  the  change  of  an 
element  to  its  opposite  practiced  in  the  dream- 
making,  for  example,  if  in  the  attack,  an  embrace 
would  be  represented,  the  arms  would  be  drawn 
backwards  convulsively.  As  far  as  possible,  the 
recognized  "arc  de  cercle"  of  the  great  hysterical 
attack  is  nothing  else  than  such  an  energetic  de- 
nial through  antagonistic  innerv^ation  of  a  posi- 
tion of  the  body  suitable  for  sexual  intercourse. 

4.  By  the  inversion  of  the  time  sequence  in  the 
phantasy  represented,  which  again  finds  its 
counterpart  in  many  dreams  which  begin  with  the 
end  of  the  action  in  order  to  conclude  with  its  be- 
ginning. The  outbreak  of  the  hysterical  attack 
follows  easily  understandable  laws.  Since  the 
repressed  complex  consists  of  libido  and  content 
of  ideas  (phantasy) ,  the  attack  can  be  occasioned 
by:  (1)  Associations,  when  the  complex  (suf- 
ificiently  deep  rooted)  is  touched  upon  by  some- 
thing of  conscious  life;  (2)  organically,  when 
from  somatic  causes  and  from  psychic  influences 
from  without,  the  amount  of  libido  is  increased  be- 


142     FREUD*S  THEORY  OF  THE  NEUROSES 

yond  a  certain  measure;  (3)  in  the  service  of  the 
primary  tendency,  as  expression  of  "the  flight 
into  sickness"  when  reaUty  becomes  painful  or 
dreaded,  thus,  for  consolation;  (4)  in  service  of 
the  secondary  tendencies  with  which  the  disease 
has  united  so  that  by  the  production  of  an  attack, 
an  advantage  to  the  patient  is  gained. 

The  investigation  of  the  childhood  history  of 
hystericals  teaches  that  the  hysterical  attack  is 
also  used  as  a  substitute  for  autoerotic  gratifica- 
tion once  practical  and  since  renounced.  In  a 
great  number  of  cases,  this  gratification  (mas- 
turbation by  rubbing  or  pressing  the  thighs 
together,  sucking  the  tongue,  etc.)  also  returns 
in  the  attack  during  a  relaxation  of  conscious- 
ness. The  involuntary  micturition  should  cer- 
tainly not  be  considered  inconsistent  with  the 
diagnosis  of  hysterical  attacks ;  it  can  repeat  the 
infantile  form  of  impetuous  pollution.  Further, 
one  can  also  encounter  the  biting  of  the  tongue  in 
undoubted  hysteria. 

The  loss  of  consciousness,^^  the  "absence"  of 
the  hysterical  attack  proceeds  from  those  transi- 
tory but  unmistakable  failures  of  consciousness 
which  are  to  be  detected  at  the  height  of  every 
intense  sexual  gratification  (also  in  the  auto- 
erotic forms).     In  the  origination  of  the  hys- 

12  Compare     Abraham,     "tjber     hysterische     Traumzustande," 
Jahrb.^  II,  1,  1910. 


HYSTERIA  143 

terical  "absences"  from  pollution-attacKs  of 
young  female  individuals,  this  development  may; 
be  followed  most  clearly. 

The  arrangement  which  opens  the  way  for  the 
repressed  libido  to  find  an  outlet  is  that  already 
present  reflex  mechanism  of  coitus  present  in 
every  man  and  also  in  women  which  we  see  be- 
come manifest  in  its  unrestricted  devotion  to 
sexuality.  The  ancients  used  to  say  "coitus  is  a 
little  epilepsy."  We  may  alter  this  to  "the  hys- 
terical convulsive  attack  is  a  coitus  equivalent." 

In  conclusion  of  the  symptoms  of  hysteria,  the 
so-called  "nervous  disturbances,"  which  play  a 
great  role  in  practice,  may  also  be  discussed. 

If  one  overlooks  the  ill-defined  classes  of  "be- 
ing nervous,"  the  nervous  disturbances  according 
to  Freud  belong  in  the  field  of  sexual  neuroses. 
The  description  of  the  true  neuroses  included  al- 
ready a  wide  array  of  psychic  and  somatic  nerv- 
ous disturbances  for  which  a  toxic  cause  is  as- 
sumed: nervous  anxiety,  irritability,  nervous  j 
palpitation,  headache,  stomachache,  sweating,  |. 
trembling,  diarrhea,  vertigo  and  many  others. 

Opposed  to  these  neuroses  of  the  heart,  in- 
testine, "vasomotor  neuroses,"  etc.,  or  associated 
with  them  are  very  often  in  individual  cases  psy- 
chogenic symptoms  which,  when  isolated,  appear 
as  mono-symptomatic  hysteria.     Thus,  for  ex- 


144     FREUD^S  THEORY  OF  THE  NEUROSES 

ample,  a  nervous  nausea,  nervous  vomiting, 
dyspepsia  (''stomach  neurosis")  has  the  same 
mechanism  of  origin  as  the  same  symptoms  in  the 
course  of  an  hysteria/^  When  a  nervous  vomit- 
ing seems  apparently  to  be  determined  by  a  re- 
cent event  and  a  somatic  preparedness  (Ent- 
gegenkommen),  indeed  if  occasionally  a  cure  by 
abreaction  of  recent  experiences  seems  to  have 
been  effected,  nevertheless,  behind  this,  a  deter- 
mination from  childhood  is  to  be  discovered  under 
which  in  the  ultimate  analysis  lies  an  erogenous 
strengthening  of  the  mouth-digestive  zone. 

The  same  apphes  to  psychic  impotence  in 
which,  often  a  recent  experience,  a  single  failure, 
seems  to  inhibit  later  results  by  anxiety,  while  in 
reality  the  hindrance  comes  from  unconscious  in- 
fantile complexes,  such  as  the  family-complex 
(unconscious  fixation  of  the  libido  upon  mother 
or  sister)  which  prevents  the  transference  of  the 
Ubido  to  the  later  sexual  object.  Of  course  an 
organic  weakness'  of  the  sexual  system  or  a  true 
neurosis  may  share  in  this  as  Steiner  and  Ferenczi 
could    show.^^     Although    the    psycho-analytic 

13  Here  belong  the  disturbances  of  appetite  in  children  which 
are  so  important  in  practice  and  often  last  for  months.  Idiosyn- 
crasies against  certain  foods  are  likewise  often  of  psychogenic 
origin. 

14  Steiner  "Die  funktionelle  Impotenz  des  Mannes  und  ihre 
Behandlung,"  Wiener  Med.  Presse,  1907,  No.  42.  Ferenczi, 
"Analyt.  Deutung  und  Behandlung  der  psychosexuellen  Impotenz 
beim   Manne,"   Fsycldatr.-Neurolog.    Wochenschr.,   No.   35,    1908. 


HYSTERIA  145 

treatment  is  effective  in  psychic  impotence,  still 
the  share  of  the  actual  conditions  is  likewise  to  be 
taken  into  consideration/^ 

In  women,  the  condition  corresponding  to  this 
is  sexual  anesthesia  which  very  frequently  accom- 
panies hysteria  but  is  also  otherwise  so  enor- 
mously widespread  that  one  must  connect  it  with 
our  all  too  Puritanical  system  of  female  educa- 
tion. Freud  was  able  to  trace  this  sexual  ane;s- 
thesia  back  to  the  following  condition:  after  the 
irritation  of  the  clitoris  by  masturbation  which 
occurred  in  childhood,  the  normally  occurring 
transference  of  the  excitability  of  the  clitoris  to 
the  adjoining  female  parts  (vagina),  as  is  neces- 
sary for  the  sensibility  in  the  normal  sexual  act, 
is  retarded  or  is  prevented  altogether.  Further, 
this  transference  normally  demands  a  certain 
length  of  time,  during  which  the  young  woman 
is  anesthetic.  It  is  recognized  that  this  anes- 
thesia of  women  is  frequently  only  an  apparent 
and  local  one.  They  are  anesthetic  at  the  vaginal 
entrance  but  in  no  way  unexcitable  at  the  clitoris 
itself  or  in  other  zones.  To  these  erogenous 
causes  of  the  anesthesia,  are  added  the  psychic 
ones  likewise  conditioned  by  the  repression.  The 
psj^chogenic  part  is  removable  by  psycho-analysis 
during  the  first  years  of  married  life. 

15  A  cure  attained  by  other  means,  as  suggestion,  cannot   be 
considered  as  an  argument  against  a  complicated  psychogenesis. 


146     FEEUD'S  THEORY  OF  THE  NEUROSES 

The  nervous  disturbances  have  an  eminently 
practical  importance  for  general  medicine  and, 
according  to  Freud's  conception,  are  very  pro- 
ductive for  the  most  diverse  specialties  outside  of 
neurology,  for  example,  internal  medicine,  eye, 
ear,  etc.,  which  employ  so  often  the  term  "nerv- 
ous." It  is  evident  that  no  physician  can  do 
without  a  knowledge  of  psycho-analysis  and  espe- 
cially the  viewpoint  of  psychogenesis  and  sexu- 
ality for  the  differential  diagnosis.  The  most 
diverse  neuralgias,  tics,  dyspepsias,  cases  of  nerv- 
ous asthma,  vaginismus,  many  cases  of  hyperem- 
esis  gravidarum,  etc.,  seem  to  be  psychically 
conditioned  and  subject  to  psycho-analytic  influ- 
ence. There  are  already  works  on  these  diseases 
which  point  to  the  psychogenic  etiology  (compare 
Dreyfuss,^^  Walthard,^^  H.  E.  MuUer)  ''  while 
Treupel  ^^  and  Wegele  ^^  lay  more  stress  on  the 
agencies  of  the  true  neuroses. 

In  this  field,  there  must  come  about  a  decision 
or  rather  a  compromise  between  the  standpoint 
represented  by  the  internists  of  all  kinds  that  for 

16  "uber  nervose  Dyspepsie,"  G.  Fischer,  Jena,  1908. 

17  "Die  psychogene  Atiologie  und  die  Psyehotherapie  des 
Vaginismus,"   Miinchn.   mediz.    Wochenschr.,   1909,   p.    1998. 

i8"Beitrage  zur  Kenntnis  der  Hyperemesis  gravidarum," 
Psychiatr.-Neurolog.  Wochenschr.,  10th  year. 

i9"uber    Herzneurosen,"    Miinchn.    mediz.    Wochenschr.,    1909. 

20«tJber  den  Zusammenhang  zwischen  Affektionen  der  Geni- 
talorgane  mit  Storungen  der  Magen-  und  Darmverdauung,"  Med. 
Klinik,  1910. 


HYSTERIA  147 

example,  bronchial  asthma  (nervous)  is  an  in- 
toxication corresponding  to  an  exudative  diath- 
esis and  the  psycho-analytic  disclosure  of  its 
psychological  connections.  Thus,  cases  of  bron- 
chial asthma  and  conditions  like  migraine, 
vasomotor  edema  and  others  which  can  occasion- 
ally stand  for  it,  are  often  plainly  psychically  con- 
ditioned. Asthma  is  an  important  symptom  of  \  J 
anxiety-hysteria  and  for  the  anxiety-neurosis  as  I  r^^"^' 
v^ell.  In  the  works  of  Stekel,^^  Stegmann,^^  and  ^ 
others  there  appear  valuable  disclosures  concern- 
ing its  psycho-sexual  nature  and  its  relief  by  psy- 
chic means,  both  of  the  individual  attack  and  the 
disease  in  general.  One  thing  is  certain, 
the  toxic  conditions  are  especially  well  suited  for 
psychogenic  complications.  Still,  there  is  the 
difficult  question  as  to  how  the  organic,  toxic  and 
psychogenic  share  in  the  causation  of  the  symp- 
toms as  well  as  the  sharp  differentiation  of  the 
still  confused  terms  "'hysterical,"  ''psychogenic" 
and  "  ( toxic )  -neurotic." 

In  this  connection,  Freud  has  pointed  out  in  a 
recent  article  ^^  on  the  elucidation  of  "psycho- 
genic visual  disturbances"  certain  disturbances 

2i"Nerv6se  Angstzustande." 

22Stegmann,  "Zur  Atiologie  des  Asthmas  bei  Kindern,"  Med, 
Klinik,  1908,  29,  Same,  "Psychotherapie  bei  Asthma  bron- 
chiale,"  Munchn,  med.  Wochenschr.,  1908.  Compare  also  Sanger, 
Brugelmann,  Goldscheider. 

23  Lit.  No.  38. 

.  i 


**-*« 


148     FREUD'S  THEORY  OF  THE  NEUROSES 

which  have  an  organic-toxic  foundation  besides 
the  psychogenic.  When  an  organ  which  serves 
both  fundamental  instincts,  the  ego-  and  the  sex- 
ual-, increases  its  sexual  role,  it  is  generally  to  be 
expected  that  this  will  not  disappear  without 
changes  in  the  excitability  and  innervation. 
When  we  see  that  an  organ  which  otherwise 
serves  the  sense  perception,  for  example,  the 
organ  of  vision,  by  the  raising  of  its  erogenous 
value,  immediately  takes  on  the  function  of  a 
genital  organ,  we  will  also  not  consider  toxic 
changes  in  it  improbable.  For  both  classes  of 
functional  disturbances  resulting  from  strength- 
ened erogenous  significance  both  of  psychological 
and  toxic  origin,  Freud  would,  for  want  of  a  bet- 
ter term,  retain  the  old  unsuitable  name  neurotic 
and  call  them  sexual-neurotic  disturbances. 

In  the  framework  of  an  attempt  at  a  compre- 
hensive representation  of  hysteria,  the  treatment 
of  the  anxiety  problem  also  has  a  place.  Anxiety 
as  the  cardinal  s\TaDtom  of  a  true  neurosis  we" 
have  already  encountered  in  the  presentation  of 
the  anxiety-neurosis,  where  according  to  Freud 
it  was  expTmned  that  the  mechanism  of  the  anx- 
iety-neurosis is  to  be  sought  in  the  separatToirof  ^ 
the  somatic  sexual  excitement  from  the  psychic 
which  causes  an  abnormal  employment  of  this  ex- 
citement. (We  have  here  to  deal  with  an  anxiety 


HYSTERIA  149 

which  does  not  have  a  psychic  derivation.     Clini- 
cally,  the  cases  of  anxiety-neurosis  are  often  seen 
mixed  with  anxiety  derived  from  psychic  sources. 
This  brought  about  the  creation  by  Freud  of  the 
term  "anxiety-hysteria,"  a  chnical  phenomenon 
to  which  Stekel  has  devoted  the  greatest  part  o 
his  book  on  anxiety  conditions  and  their  treat- 
ment, which  is  especially  important  for  the  prac-    I 
titioner.     In  these  cases,  the  anxiety  arises  not    jl 
only  from  somatic  sources  but  from  a  part  of  the    ;   / 
iGngfatified  libido  which   embraces  unconscious  7  r^^'^'^^ 
complexes  and  through  the  repression  of  these  ^ 
gives  rise  to  neurotic  anxiety.     As  the  mind 
normally  reacts  to  impending  danger  from  with- 
out by  anxiety,  so  one  might  say  that  in  neurotic 
anxiety,  the  ego  is  defending  itself  against  in- 
ternal enemies.     In  these  cases,  we  have  a  psychic 
mechanism  which  is  identical  with  that  of  hy§=^' 
teria  except  that  it  does  noFTSTdTo  conversion 
into  physical  symptoms  but  into  the  development 
of  anxiety.     Anxiety  is  likewise  the  only  symp- 
tom into  which  the  psychic  excitement  is  con- 
verted in  this  case.     In  cases  as  they  occur  in 
practice,  this  anxiety-hysteria  may  be  mixed  in 
any  degree  with  the  conversion-hysteria:  there 
may  be  conversion-hysteria  without  any  anxiety 
as  well  as  pure  anxiety-hysteria  which  expresses 
itself  in  feelings  of  anxiety  and  phobias.     Freud 
has   already   in   his   work   on   anxiety-neurosis 


150  FREUD'S  THEORY  OF  THE  NEUROSES 

pointed  out  the  frequent  combination  of  hysteria 
'7  with  anxiety-neui'osis.  This  is  explained  by  the 
fact  that  very  often  besides  the  somatic  diver- 
sion of  the  libido,  a  part  of  the  same  may  strike 
back  to  the  unconscious  complexes  and  bring 
these  to  life  again.  It  is,  therefore,  not  chance 
when  hysteria  and  anxiety-neurosis  so  frequently 
combine,  and  experience  shows  that  in  many 
cases  which  look  exactly  like  anxiety-neurosis 
one  finds  a  bit  of  hysteria  as  well.  In  this 
sense,  Freud  says  anxiety-neurosis  may  be  called 
the  somatic  partner  of  hysteria.  Here  as  there,  is 
an  accumulation  of  excitation  in  which  perhaps 
the  similarity  of  the  symptoms  is  founded.  Here 
as  there,  a  psychic  insufficiency  which  comes  into 
existence  in  consequence  of  abnormal  somatic 
processes.  Here  as  there,  in  place  of  mental 
elaboration,  a  diversion  of  the  excitation  into  the 
somatic  takes  place ;  the  distinction  lies  merely  in 
the  fact  that  the  excitation,  in  the  displaceiJient 
of  Tgfrich  the  neurosis  finds  expression,  is,  in  the 
arixiety-neurosis,  a  purely  somatic  one  (the 
somatic  sexual  excitement),  iuythe  hysteria,  a 
psychic  one  (through  the  conflicts  aroused). 
"**^  Thus,  there  is  an  hysterical  anxiety  wliicliris 
psychically  divertible.  In  these  cases,  a  psychic 
libidinous  excitation,  a  phantasy,  suppressed  in 
the  struggle  with  the  ego-instinct,  finds  its  way 
back  bjr  regression  to  pathogenic  infantile  uncon- 


HYSTERIA  151 

scious  material  which,  however,  is  not  converted 
as  formerly  into  physical  symptoms,  but  is  plainly 
changed  in  a  way  prepared  in  infancy  into  anx- 
iety. Neurotically  increased  anxiety  we  fre- 
quently find  in  children.  We  see  what  you  might 
call  a  normal  anxiety  arise  in  them  in  the  dark- 
ness when  they  miss  the  beloved  person.  A  neu- 
rotic anxiety  arises  in  children  if  they  suddenly 
come  in  contact  with  the  sexual  problem  without 
being  able  to  master  it  psychically.  The  most 
frequent  pathological  expression  of  this  anxiety 
of  children  is  the  pavor  nocturnus  as  the  founda- 
tion for  which  a  sexual  experience  in  the  broadest 
sense  of  the  word  may  regularly  be  proven. 
When  one  searches  in  these  children  for  the  con- 
tent of  their  horrible  dreams  or  phantasies  and 
investigates  the  meaning  of  what  you  mi^ht  call 
the  somnambulistic  condition,  the  repressed  ma- 
terial regularly  appears.  The  most  frequent 
neurosis  of  childhood  is  anxiety-hysteria  ^^  which 
is  to  be  considered  in  general  the  most  frequent 
of  all  psychoneurotic  maladies.  As  an  essential 
characteristic  of  the  anxiety-hysteria  it  may  be 
asserted  that  it  always  tends  more  and  more  to 
develop  a  phobia ;  in  the  end,  the  patient  may  be- 
come free  from  anxiety  but  only  at  the  price  of 

24  Compare  Freud's  "Analyse  der  Phobie  eines  fiinfjahrigen 
Knaben,"  Jahrb.,  I,  and  Jung,  "tJber  Konflikte  der  kindlichen 
Seele,"  Jahrb,,  II,  1. 


152     FREUD'S  THEORY  OF  THE  NEUROSES 

inhibitions  and  limitations  to  which  he  must  sub- 
mit. In  anxiety-hysteria,  from  the  beginning 
on,  there  is  a  progressive  psychic  attempt  to  join 
the  free  anxiety  psychically  (to  something)  but 
this  work  can  neither  effect  the  reversion  of  this 
anxiety  into  libido  nor  join  it  to  the  same  com- 
plexes from  which  the  hbido  arose.  There  re- 
mains nothing  left  for  it  but  to  stop  every  pos- 
sible opportunity  for  the  development  of  anxiety 
by  a  psychic  screen  of  a  kind  of  foresight,  an  in- 
hibition, a  prohibition,  and  it  is  these  protective 
structures  which  appear  to  us  as  phobias  and  con- 
stitute the  nature  of  the  malady  for  our  percep- 
tion. The  variety  of  this  inhibition  whether  it  is, 
for  example,  a  disturbance  of  gait  or  a  disturb- 
ance of  the  mouth  zone  (disturbance  of  eating  or 
speaking),  etc.,  will  depend  on  what  organic 
function,  constitutionally  emphasized  and  erog- 
enously  strengthened,  the  anxiety  attaches  it- 
self. The  anxiety  leads  to  a  phobia,  you  might 
say,  when  it  gets  firmly  fixed  on  a  particular  com- 
plex. The  most  frequent  of  hysterical  phobias  is 
the  agoraphobia  (Platzangst)  for  which  it  is 
characteristic  that  it  leads  to  no  absolute  inhibi- 
tion but  only  to  preventing  the  patient  from  go- 
ing alone,  though  he  can  walk  when  accompanied 
by  specified  persons.  Often  an  attack  of  anx- 
iety on  the  street  is  the  occasion  of  the  origin  of 
the  agoraphobia ;  the  symptom  is  thus  constituted 


HYSTERIA  15S 

to  prevent  an  outbreak  of  anxiety;  the  phobia  is 
erected  as  a  frontier  fortress  against  the  anxiety. 
\  I  At  the  bottom  of  the  agoraphobia  seem  to  be  vari- 
ous sexual  and  covetous  wishes  which  have  been 
repressed  into  the  unconscious.  \\  These  are 
mostly  erotic  desires  which  in  men  are  also  accom- 
panied by  covetous  phantasies.  The  symbolic 
meaning  of  certain  figures  of  speech  as  "to  bring 
it  far,"  "to  come  to  something,"  "to  stand  on  your 
own  feet,"  etc.,  frequently  play  an  overdetermin- 
ing  role;  similarly  also  in  the  wish  "to  go 
through."  Recently,  Freud  has  called  atten- 
tion ^^  in  an  aphoristic  observation  to  the  deeper 
connections  of  such  cases  of  neurotic  disturbance 
of  gait  and  "spatial  anxiety"  to  the  original  pleas- 
ure in  motion  of  children  which  is  joined  to  sex- 
ual excitations  and  voluptuous  sensations.  An- 
other anxiety-hysterical  disturbance  already  con- 
nected to  superficial  observation  with  sexual 
etiological  agencies  is  the  erythrophobia  at  the 
bottom  of  which  frequently  lies  the  self-reproach 
of  shame  over  masturbation  or  the  experience  of 
syphilis.  Also,  premature  sexual  knowledge,  se- 
cretly obtained  from  observation  of  the  parents 
and  imperfect  interpretation  of  this,  seems  to 
play  a  role.     Likewise,  feelings  of  being  slighted 

25  Concerning  muscular  activity  as  a  source  of  sexual  excite- 
ment in  childhood,  compare  "Drei  Abhandlungen  zur  Sexual- 
theorie,"  Lit.  No.  20. 


u/W 


154  FREUD'S  THEORY  OF  THE  NEUROSES 

and  anger  may  enter  in  ( Adler) .  If  this  anxiety 
over  red  leads  to  inhibitions  in  the  hfe  activities, 
for  example,  if  it  prevents  mingling  in  society,  it 
becomes  a  phobia. 

Concerning  vocational  anxiety-neuroses,  stage 
fright,  examination-anxiety,  psychic  impotence 
depending  on  anxiety,  etc.,  Stekel  has  sought  to 
give  in  his  book  psycho-analytic  explanations 
with  detailed  casuistic  material. 

Without  the  meaning  of  neurotic  anxiety  as 
having  originated  from  the  repression  of  libidi- 
nous imx^iilses,  the  anxiety-dream,  an  almost  uni^ 
versal  experience,  wliicli  is  also  a  frequent  symp- 
tom of  the  neurosis,  cannot  be  understood.  The 
theory  of  the  anxiety  dream  does  not  belong  to 
the  problem  of  the  normal  dream  but  to  the  anx- 
iety problem.  The  anxiety-dream  seems  at  first 
to  contradict  the  dream-theory  that  every  dream 
represents  a  wish  fulfilled.  When  one  has 
clearly  shown,  however,  what  lurks  behind  the 
manifest  dream  content  of  the  anxiety-dream  and 
penetrated  to  the  latent  psychic  content,  the  ob- 
jection to  the  wish  theory  falls  to  pieces.  The 
interpretation  work  shows  that  the  anxiety  which 
we  feel  in  dreams  is  only  apparently  explained  by 
the  content  of  the  dream.  The  anxiety  is,  as  al- 
ready remarked,  only  attached  to  the  accompany- 
ing idea  and  springs  from  other  sources.  The 
interpretation  of  such  dreams  regularly  reveals 


HYSTERIA  155 

their  true  content  to  be  a  repressed  sexual  wish, 

portion  of  Y{^\ch  in  tl^e  dream  has  failed.  ^| 
'o'the  breaking  through  of  the  sexual  in  the     | 
dream  which  is  also  apt  to  awaken  the  sleeper,    / 
the  dreamer  can  only  react  like  the  neurotic  in 
waking  life,  namely,  by  anxiety.     In  this  sense, 
the  representation  of  the  unconscious  in  the  anx- 
iety-dream would  be  an  especially  successful  one. 
'iTie  anxiety  in  these  dreams  is  thus  mostly  a 
psychoneurotic  one  arising  from  psycho-sexual 
impulses  whereby  the  anxiety  corresponds  to  re- 
pressed  libido^    Then,  this  anxiety  has,  like  the 
whole  anxiety-dream,  the  significance  of  a  neu- 
rotic symptom  and  we  stand  on  the  boundary 
where  the  wish-fulfilling  tendency  of  the  dream 
fails.2^ 

Anxiety-dreams  are  of  frequent  occurrence  in 
anxiety-neurosis  an5  anxiety-hysteria,  where  they 
show  the  following  characteristic  coritent.^^  The 
dream  picture  accompanied  by  anxiety  represents 
the  patient  (usually  female)  oppressed  by  a 
great  and  dangerous  beast  which  threatens  to 
throw  itself  on  the  dreamer;  characteristically,  it 

2«In  other  anxiety-dreams,  the  feeling  of  anxiety  is  somatically 
caused,  as  for  example,  in  lung  and  heart  diseases  and  is  then 
made  use  of  to  bring  to  fulfillment  in  the  dream  of  suppressed 
wishes  in  individuals  whose  dreams  had  already  had  anxiety  from 
psychic  motives. 

27  Compare  in  this  connection  Ferenczi,  "The  Psycho-analysis 
of  dreams,"  Amer.  Jour,  Psychology,  Apr.,  1910,  as  well  as 
Stekel's  cited  work. 


156  FREUD'S  THEORY  OF  THE  NEUROSES 

is  often  a  stallion  or  a  bull,  thus,  animals  which 
have  ever  stood  as  symbols  of  the  potent  strength 
of  animal  masculinity.  It  is  easy  to  see  in  these 
animal  figures  the  symbolized  givers  of  sexual 
gratification  forbidden  by  conscious  thinking.  A 
still  plainer  symbolism  aiming  at  this  end  appears 
in  dreams  of  burglars  who,  armed  with  revolvers, 
daggers,  or  similar  instruments,  press  in  upon 
the  dreaming  lady.  The  starting  up  from  sleep 
because  of  such  anxiety-dreams,^^  one  finds  fre- 
quently in  widows  and  ungratified  women  as  a 
characteristic  kind  of  disturbance  of  sleep. 
Stekel  ^^  especially  emphasizes  the  dream  of  the 
death  of  the  child  who  stands  in  the  way  of  break- 
ing the  marriage  or  prevents  the  divorce;  in  gen- 
eral, dreams  of  death  and  funerals,  especially  of 
near  relatives,  are  typical  for  the  anxiety- 
neuroses. 

For  want  of  clinical  material,  Freud  had  rela- 
tively little  opportunity  to  deal  with  the  out- 
spoken psychoses ;  still,  he  considered  these  within 
the  scope  of  his  investigations.  The  few  cases  to 
which  he  himself  has  applied  the  insight  gained 
from  the  psycho-neuroses  have  yielded  highly  im- 

28  Recently  Ernest  Jones  has  sought  to  elucidate  the  nightmare 
from  Freudian  standpoint,  "On  the  Nightmare,"  Amer.  Jour. 
Insanity,  Jan.,  1910. 

29  This  repressed  wish  can  express  itself  as  an  obsessional  im- 
pulse to  injure  or  kill  the  child.    Compare  Lit.  No.  6. 


HYSTERIA  '^isr 

portant  disclosures  and  really  incited  the  Zurich 
clinic  to  splendid  work.  Through  the  dogma,  in- 
sanities are  brain  diseases,  and  through  scientific  .  # 
work  chiefly  devoted  to  njojogj^phj,  the  psycho-  v  \hj 
logical  way  to  the  understanding  of  the  psychoses 
was  little  used.  Freud  joined  Griesinger  who 
ascribed  to  the  psychic  causes  the  predominant 
role  in  the  causation  of  the  psychoses.  Freud  di- 
vided the  cases  analyzed  by  himself  into  ^^over-_ 
jgowering  psychoses"  and  "defense-psychoses." 
Under  the  former,  he  classed  those  cases  in  whic'E 
the  unconscious  had  completely  and  violently 
overcome  the  conscious.  Freud  reported  one 
such  case,  met  with  in  the  course  of  an  hysteria, 
of  an  hallucinatory  confusion  (of  which  he  had 
seen  a  few)  in  which  the  person  (in  sense  of  Grie- 
singer) represented  the  fulfillment  of  her  re- 
pressed wishes  in  hallucinatory  manner,  while 
she  awaited  in  vain  an  appointed  day  with  her 
lover,  suddenly  had  hallucinations,  hastened  to 
meet  him,  greeted  him  and  for  two  months  lived 
in  the  happy  dream  that  he  was  there,  always  near 
her,  etc.  Thus,  the  patient  has  warded  off  the 
unbearable  idea  of  remaining  away  from  a 
longed-for  lover  in  energetic  and  in  a  certain 
sense,  successful  manner,  while  the  ego  rejects 
the  unbearable  idea  together  with  its  affect  and 
behaves  as  if  the  idea  had  never  occurred  to  it. 
But  in  the  moment  in  which  this  succeeded,  the 


158  FREUD'S  THEORY  OF  THE  NEUROSES 

person  is  already  in  a  psychosis  whicK  one  can 
classify  only  as  hallucinatory  confusion.  Thus, 
the  ego  tears  itself  loose  from  the  unbearable 
idea;  this  is  inseparably  connected  with  a  piece 
of  reality  however,  and  while  the  ego  accom- 
plishes this  task,  it  has  separated  itself  in  whole 
or  in  part,  from  reality.  According  to  Freud, 
this  is  the  condition  in  which  hallucinatory 
vivacity,  amid  its  own  ideas,  is  to  be  judged. 

In  contrast  to  this  overcoming  en  masse,  the 
analogy  to  hysteria  in  the  defense-psychoses 
(paranoia,  dementia  paranoides)  is  complete  so 
y  that  in  the  initial  stag^es  of  thesejcases,  they  often 
cannot  be  sharply  differentiated  from  hysteria 
and  other  neuroses.  In  these  cases  of  defense- 
psychosis,  the  whole  previous  history,  course  of 
development,  genesis,  complexes  and  infantile 
repression  are  the  same  as  in  cases  of  hysteria. 
It  seems  that  the  different  clinical  pictures  of  the 
defense-psychoses  are  characterized  only  by  dif- 
ferent repression  mechanisms  which  come  into 
play  later,  concerning  which,  however,  nothing 
definite  is  known.  The  libido  may  have  suffered 
a  quite  special  fate  in  this.  Thus,  in  dementia 
prascox,  there  seems  to  be  a  characteristic  with- 
drawal of  the  libido — the  term  taken  in  its  broad- 
est sense — from  the  objects  of  the  external 
world. 

Therein,   lies  an   exquisite  contrast  to  hys- 


HYSTERIA  159 

teria  to  which  Abraham  has  referred.^^  While 
in  hysteria  there  is  much  free  floating  libido  for 
the  use  of  the  object,  in  certain  cases  of  the 
psychosis  it  seems  to  be  fastened  to  the  ego  com- 
plex and  thus  leads  to  ideas  of  grandeur.  Thus 
is  also  explained  the  inner  connection  between 
persecution  mania  and  delusions  of  grandeur  in 
the  paranoiad  forms. 

Freud  has  described  in  detail  a  case  of  haUuci- 
natory  paranoia  ^^  analyzed  by  him,  in  wlncITne 
shows  that  a  group  of  cases  which  belong  to  para- 
noia arise  just  like  hysteria  and  the  obsessional 
neurosis  from  the  repression  of  painful  memories 
and  that  the  symptoms  of  these  are'determined  fn 
form  by  the  content  of  the  repressed  material. 
Further,  in  this  case,  the  repressed  material  was 
revealed  as  a  sexual  experience  of  childhood 
(phantasy),  the  content  of  which,  however,  does 
not  have  to  be  recovered  by  the  tedious  way  of 
analytic  interpretation  work  but  which  the  pa- 
tient, as  in  all  cases  of  paranoia,  expressed  quite 
undisguised.  In  paranoia,  much  pushes  into 
consciousness  which  we  proved  to  exist  in  the  un- 
conscious of  normal  and  neurotic  individuals  only 
by  psycho-analysis.     Thus,  the  phantasies  of  hys- 

80  "Die  psychosexuellen  Differenzen  zwischen  Hysteric  und 
Dementia  praecox,"  Zentralblatt  f.  Psych,  u.  Neurol.,  July,  1908. 

31  Perhaps  more  correctly  called  dementia  paranoides.  Lit 
No.  3. 


160     FREUD'S  THEORY  OF  THE  NEUROSES 

tericals  which  have  to  he  made  conscious  hy  analy- 
sis hide  themselves  from  sexual  and  cruel  mal- 
treatment, for  example,  occasionally  as  far  as  in 
individual  cases  the  complaint  of  paranoiacs, 
"persecuted."  It  is  worthy  of  note,  hut  not  in- 
comprehensible in  the  light  of  the  Freudian 
sexual  theory,  that  the  identical  content  meets  us 
as  reality  in  the  arrangements  of  perverts  for 
the  gratification  of  their  appetites. 

For  the  periodic  melancholia,  Freud  asserts 
that  these  cases  appear  to  dissolve  in  unexpected 
frequency  into  obsessional  ideas  and  obsessional 
affects,  a  perception  which  is  not  of  indifferent 
importance  therapeutically.  The  individual  at- 
tack of  ill  humor  may  be  favorably  influenced 
psycho-analytically  even  if  further  attacks  may 
not  always  be  prevented. 

In  this  relatively  small  casuistry  Freud  has 
been  able  to  show  that  sense  and  logic  may  be 
demonstrated  in  delusions,  as  also  in  the  peculiar 
variety  of  unconscious  thinking,  and  has,  thereby, 
brought  the  cause  and  content  of  mental  disturb- 
ances into  psycho-analytic  investigation.  The 
Zurich  school,  with  Jung  at  its  head,  has  busied 
itself  according  to  the  clinical  material  at  its  com- 
mand, with  especial  attention  to  dementia  praecox. 
Jung's  painstaking  labors  in  the  analysis  of 
every  expression  of  a  very  averse  dement  suc- 
ceeded in  showing  the  same  psychic  mechanisms 


HYSTERIA  161 

which  Freud  had  found  in  the  neuroses  also  pres- , 
ent  here  in  demonstrable  form,  so  that  no  more? 
doubt  can  exist  that  at  the  bottom  of  dementia 
pr^ECOx  lies  a  repressed  erotic  complex.^^  The 
dulling  of  the  affect  is  only  apparent  and,  accord- 
ing to  Jung,  explained  by  its  absorption  by  the 
ruling  complex.^^  The  psycho-analytic  study  of 
these  conditions  has  yielded  still  more.  It 
showed  that  the  apparently  absurd  symptoms  of 
dementia  prsecox  prove  on  analytic  investigation 
to  be  symbolic  figures  of  intelligible  and,  in  the 
mental  life  of  the  person,  highly  important  trains 
of  thought  and  impulses.^*  Abraham  has 
brought  out,  beside  the  article  already  mentioned 
on  the  withdrawal  of  the  libido  from  the  external 
world  which  is  so  especially  characteristic  of 
dementia  prsecox,  also  another  article  on  the  sig- 
nificance of  dreams  of  youth  for  the  symp- 
tomatology of  dementia  prsecox;  ^^  Maeder  ^^  has 
dealt  in  detail  with  the  delusional  structures  of 
the  paranoiad  conditions.     Riklin  published  a 

82  Jung,  "t^ber  die  Psychologie  der  Dementia  praecox,"  K. 
Marhold,  Halle,  1907. 

33  Compare  also  Bleuler-Jung,  "Komplexe  als  Krankheitsur- 
sachen  bei  Dementia  praecox,"  Zentralb,  f,  Nervenheilkunde  u. 
Psychiatrie,  1908. 

84  Jung,  "Der  Inhalt  der  Psychose,"  Schr.  z.  angew,  Seelen- 
kunde,  3,  1908. 

^^  Zentralhlatt  filr  Nervenheilkunde  und  Psychiatrie,  1907. 

36  "Psychologische  Untersuchungen  an  Dementia  prsecox- 
Kranken,"  Jahrb,,  II,  1,  1910. 


162  FREUD'S  THEORY  OF  THE  NEUROSES 

"contribution  to  the  psychology  of  cataleptic  con- 
ditions in  catatonia."  ^^  Freudian  mechanisms 
could  also  be  shown  in  various  other  psychoses. 
Thus  Bleuler/^  in  his  work  on  "Freudian 
mechanisms  in  the  symptomatology  of  the  psy- 
choses," furnished  a  series  of  interesting  ex- 
amples. Otto  Gross  considered  "the  Freudian 
idiogenesis  agency  and  its  significance  in  manic 
depressive  insanity  of  Kraepelin"  (Leipzig, 
1907) .  In  this  work  appears  also  a  reference  to 
the  psycho-genesis  of  kleptomania.^^  Finally, 
there  follows  a  short  reference  to  some  published 
works  of  Jung:  "A  Case  of  Hysterical  Stupor 
in  a  Prisoner  Under  Trial,"  further  "Concern- 
ing Simulation  of  Insanity."  ^^  On  the  psy- 
chology of  hysterical  twilight  states,  Riklin  ^^  and 
Schwarzwald^^  have  published  contributions. 
"On  Obsessional  Psychoses"  Warda  ^^  has  writ- 

37  Riklin,  "Beitrag  zur  Psychologic  der  kataleptischen  Zustande 
bei  Katatonie,"  Psychiatr.-N enrol.   Wochenschr.,  1906,  No.  32. 

38Bleuler,  "Freudsche  Mechanismen  in  der  Symptomatologie 
der  Psychosen,"  Psychiatr.-Neurolog.  Wochenschr.,  1906,  Nos. 
35-36. 

39  Compare  also  Stekel,  "Die  sexuelle  Wurzel  der  Kleptomania,** 
Zeitschrift  f.  Sexualwissenschaft,   1st  year. 

40  Jung,  "Ein  Fall  von  hysterischen  Stupor  bei  einem  Unter- 
suchungsgefangenen,"  and  "uber  Simulation  von  Geistesstorung." 
Journal  f.  Psychologie  u.  Neurologic,  190^  and  1905. 

41  Psychiatr.-Neurolog.  Wochenschrift,  1904. 
^2  Journal  f.  Psychologie  u.  Neurologic,  1909. 

43  Warda,  "trber  Zwangsvorstellungspsychosen,"  Monatsschr.  f. 
Psychiatric  und  Neurologic,  1903, 


HYSTERIA  163 

ten.  Stekel  has  undertaken  an  analysis  of  a  ease 
of  melancholia.^*  Jones  reports  on  a  case  of 
hypomania/^  Maeder*®  on  a  psycho-analysis  of 
a  melancholic  depression  and  Riklin  *^  on  prison 
psychoses. 

From  this  enumeration,  which  does  not  pre- 
tend to  be  complete,  it  may  be  recognized  how 
much  promise  for  psychiatry  is  held  out  by  the 
Freudian  theory  of  the  neuroses. 

*4  Compare  "Die  Angstzustande." 

45  "Psycho-analytic  notes  on  a  case  of  hypomania,"  Amer, 
Jour.  Insanity,  1910. 

46"Eine  Psychoanalyse  bei  einer  melancholischen  Depression," 
Zentralhlatt  f.  Neurologic  u.  Psychiatrie,  1910,  page  50. 

47  "tJber  Gefangnispsychosen,"  Psychiatri.-Neurol.  Wochenschr., 
1909. 


CHAPTER  VII 

THE   OBSESSIONAL  NEUROSIS 

Relation  to  Hysteria.  Substitution  Instead  of 
Conversion.  Characteristic  Obsession,  ^'Nature  and 
Mechanism  of  the  Obsessional  Neurosis"  (1896).  "Re- 
marks on  a  Case  of  Obsessional  Neurosis"  (1909).  Sig- 
nificance of  Instinct  in  Life  (Sadism).  Love  and  Hate ; 
Obsession  and  Doubt.  Mechanism  of  Distortion. 
Some  Mental  Peculiarities  of  the  Obsessed. 

As  a  result  of  Freud's  work,  the  obsessional 
neurosis  has  received  an  important  elucidation 
and  the  treatment  of  this  affliction,  which  is  often 
so  severe  as  to  undermine  every  happiness  of 
life,  seems  to  warrant  a  much  better  prognosis. 
To  be  sure,  those  suffering  from  this  neurosis, 
the  symptoms  of  which  often  appear  in  child- 
hood, must  come  under  treatment  early.  The 
explanation  of  this  complicated  clinical  picture 
is  accompanied  by  much  greater  difficulties  than 
the  interpretation  of  hysteria,  and  Freud  himself 
admits  that  even  he  has  not  yet  succeeded  in  com- 
pletely elucidating  a  case  of  obsessional  neurosis ; 
still,  there  has  recently  appeared  a  most  illumi- 

164 


THE  OBSESSIONAL  NEUROSIS  165 

nating  work  by  Freud  which  utilizes  the  results 
of  his  investigations  during  the  past  years,  es- 
pecially regarding  the  nuclear-complex  and  in- 
stinctive life,  in  explaining  a  case  of  obsessional 
neurosis. 

In  the  exposition  of  the  theory  of  the  psy- 
choneuroses,  the  fact  has  already  been  repeatedly 
mentioned  and  emphasized  that  the  presupposi- 
tions of  the  obsessional  neurosis  are  in  part  the 
same  as  in  hysteria  and  that  their  origin  likewise 
rests  on  the  unsuccessful  repression  of  psycho- 
sexual  factors.  The  differences  are  due  to  the 
fact  that  here  a  different  repression  mechanism 
and,  because  of  the  breaking  through  of  re- 
pressed material,  a  different  kind  of  symptom 
formation  comes  into  existence.  The  affect  of 
the  painful  idea  does  not  become  transformed 
into  physical  symptoms  as  in  hysteria  (conver- 
sion) ,  but  affixes  itself  to  other  ideas,  not  in  them- 
selves unbearable,  thus  producing  by  this  false 
relationship,  obsessions  (substitution).  Charac- 
teristic of  obsessive  ideas  and,  in  a  broader  sense, 
of  obsessive  mental  processes  in  general,  is  that 
paradoxical  feeling  of  compulsion  or  obsessive- 
ness  (Zwang)  in  which  absurd  or  quite  harmless 
ideas  stand  in  the  foreground  of  consciousness 
and  resist  dislodgment  by  logic,  even  proving 
completely  refractory  to  it.  This  arises  from  the 
fact  that  the  contents  of  these  obsessive  mental 


166  FREUD'S  THEORY  OF  THE  NEUROSES 

processes  are  only  false  labels,  carriers  of  affects 
which  do  not  really  belong  to  them.  Conscious 
logical  effort  exerts  itself  in  vain  inasmuch  as 
it  only  reaches  a  sphere  of  mental  activity  where 
it  can  accomplish  no  useful  end.  The  displace- 
ment of  the  affect  onto  the  substituted  idea  thus 
attains  the  end  of  making  the  real  connection 
unrecognizable  and  the  work  of  logic  fruitless. 
Only  when  by  the  aid  of  psycho-analysis  the  true 
relation  of  the  obsessive  ideas  to  the  infantile 
material  is  made  conscious  can  the  obsession  be 
removed.  The  analytic  therapy  proceeds,  there- 
fore, upon  the  following  assumption,  which  is 
also  demonstrable  elsewhere  in  mental  life: 
where  there  occurs  a  mesalliance  between  an  idea 
and  an  affect,  hence  between  the  intensity  of  a 
self-reproach,  for  example,  and  the  occasion  for 
the  reproach,  the  laity  would  say  that  the  affect  is 
too  strong  for  the  occasion,  hence  excessive  and 
the  deduction  drawn  from  the  reproach  is  there- 
fore false.  The  psycho-analyst,  on  the  contrary, 
has  to  say:  no,  the  affect  is  justified,  the  con- 
sciousness of  guilt  is  not  to  be  criticized;  it  be- 
longs to  another,  unknown  (unconscious)  con- 
tent which  must  be  uncovered. 

As  already  mentioned,  infantilism  and  sexu- 
ality possess  a  fundamental  etiological  signifi- 
cance for  the  obsessional  neurosis  as  well  as  for 
hysteria,  although  in  the  obsessional  condition 


THE  OBSESSIONAL  NEUROSIS  167 

these  exhibit  certain  peculiarities.  The  sexual  ^ 
activities  of  childhood  are  manifested  in  a  par- 
ticularly active  manner;  without  exception,  these 
are  children  who  even  in  early  life  betray  very 
intense  aggressiveness.  In  contrast  to  hysteria, 
this  characteristic  of  precocious  sexual  activity  is 
absent  in  no  case  of  obsessional  neurosis.  With 
this  difference  is  connected  another,  namely,  that 
in  this  neurosis  the  male  sex  seems  to  have  the 
preference.  In  general  the  obsessional  neurosis 
shows  much  more  clearly  than  hysteria  that  the 
agents  causing  the  neurosis  are  to  be  sought,  not 
in  the  actual  but  in  the  infantile  sexual  life.  The 
necessary  infantile  basis  of  the  obsessional  neu- 
rosis, in  distinction  to  that  of  hysteria,  is  not  al- 
ways completely  lost  in  amnesia;  in  particular, 
the  idea  which  is  separated  from  its  aflFect  is  fre- 
quently present  and  treated  as  of  no  consequence 
by  the  patient's  consciousness.  Etiologically, 
these  two  neuroses  stand  close  together  and  fre- 
quently appear  in  combination.  At  the  bottom 
of  an  obsessional  neurosis,  the  analysis  often  re- 
yeals  a  bit  of  hysteria. 

The  first  detailed  work  of  Freud's  on  the  obses- 
sions ^  contains  the  most  important  features  of  the 

i"Weitere  Bemerkungen  iiber  die  Abwehr-Neuropsychosen" 
(1896),  Lit.  No.  8.  Earlier  compare  under  "Die  Abwehrneu- 
ropsychosen'*  (1894),  Lit.  No.  53.  "Obsessions  et  phobies;  leur 
mecanisme  psychique  et  leur  etiologie'*  (1895),  Lit.  No.  6. 


168     FREUD'S  THEORY  OF  THE  NEUROSES 

analysis  of  this  clinical  picture  but  was  later 
found  by  Freud  himself  to  require  improvement 
in  certain  particulars.  Nevertheless,  for  the  stu- 
dent, this  vrork,  because  of  its  schematic  presenta- 
tion of  this  clinical  picture  with  its  most  compli- 
cated psychology,  is  an  especially  good  guide. 

According  to  Freud's  original  exposition,  the 
typical  course  of  a  case  of  obsessional  neurosis 
would  be  something  as  follows :  In  a  first  period 
— period  of  childish  immorality — the  events  con- 
taining the  seed  of  the  later  neurosis  occur.  In 
earliest  childhood,  the  acts  of  sexual  aggression 
take  place  against  the  other  sex  which  later  ap- 
pear in  actions  symbolizing  reproach.  This 
period  is  brought  to  an  end  by  the  appearance  of 
sexual  maturity,  often  self -induced.  Now  a  re- 
proach becomes  joined  to  the  memory  of  those 
sensual  acts,  this  is  repressed  and  replaced  by 
a  primary  defense  symptom.  Scrupulousness, 
shame,  self-distrust  are  such  symptoms,  with 
which  the  third  period,  that  of  apparent  health 
but  really  successful  defense,  begins. 

The  next  stage,  that  of  actual  sickness,  is  char- 
acterized by  the  return  of  the  repressed  material, 
that  is,  by  the  failure  of  the  defense.  The  re- 
vived impulses  and  memories  as  well  as  the  re- 
proaches formed  from  them  penetrate  conscious- 
ness but  never  in  unchanged  form,  always  as  ob- 
sessive idea  and  obsessive  affect  and  the  patho- 


THE  OBSESSIONAL  NEUROSIS  169 

genic  memory  substituted  for  the  conscious  life; 
thus  are  formed  compromise  formations  between 
the  repressed  and  repressing  ideas,  so  that  the  re- 
pressing material  may  again  be  identified  in  the 
symptoms  alongside  some  of  the  repressed. 

In  the  further  course  of  the  development  of  the 
neurosis  two  forms  of  the  disease  can  be  differ- 
entiated according  as  only  the  memory  content  of 
the  act  symbolizing  reproach  forces  an  entrance 
into  consciousness  or  is  accompanied  by  the  re- 
proach-ajffect.  The  first  case  is  that  of  the  typical 
obsession  in  which  the  content  attracts  the  pa- 
tient's attention  accompanied  by  only  an  indefi- 
nite feeling  of  discomfort  as  affect,  whereas  only 
the  affect  of  reproach  would  be  suitable  for  the 
content  of  the  obsessive  idea.  In  the  second 
form  of  obsessional  neurosis  the  reproach-affect 
can,  by  a  psychic  addition,  change  itself  into  any 
other  unpleasant  affect;  if  this  has  hax^pened, 
then  nothing  more  stands  in  the  way  of  the  sub- 
stituted affect's  becoming  conscious.  Thus  the 
reproach  (of  having  carried  out  some  sexual  acts 
in  childhood)  is  easily  changed  into  shame  (if 
another  becomes  aware  of  it),  into  hypochon- 
driacal anxiety  (because  of  the  injurious  phys- 
ical consequences  of  those  reproachful  acts),  into 
social  anxiety  (fearing  punishment  by  society 
for  that  offense),  into  religious  anxiety,  into  the 
delusion  of  being  observed   (fear  of  betraying 


170     FREUD'S  THEORY  OF  THE  NEUROSES 

those  acts  to  others),  into  fear  of  being  tempted 
|( justified  distrust  in  tl^eir  own  power  of  resist- 
ance) and  so  on.  Therewith,  the  memory  con- 
tent of  the  act  symbolizing  reproach  can  be  pres- 
ent in  consciousness  or  entirely  absent,  which 
greatly  complicates  the  diagnostic  difficulties. 
Many  cases  which  a  superficial  examination  calla.  4 
general  (neurasthenic)  hypochondria  belong  to 
this  group  of  obsessive  affects;  especially  do  the 
so-called  "periodic  neurasthenia"  or  "periodic 
melancholia"  (cyclothymia)  seem  in  unexpected 
frequency  to  resolve  into  obsessive  affects  or  ob- 
sessive ideas,  a  perception  which  is  not  of  slight 
therapeutic  importance. 

Besides  these  compromise  symptoms  which  sig- 
nify the  return  of  the  repressed  material  and 
thereby  a  failure  of  the  originally  achieved  de- 
fense, the  obsessional  neurosis  forms  a  series  of 
other  symptoms  of  a  totally  different  origin. 
The  ego  seeks  to  defend  itself  against  those  de- 
scendants of  the  initial  repressed  memory,  and 
in  this  conflict  produces  symptoms  which  Freud 
has  grouped  together  under  the  name  "secondary 
defense."  These  are  without  exception  pro- 
tective measures  which  have  performed  good  serv- 
ice in  the  struggle  against  the  obsessions  and  ob- 
sessive affects.  If  these  aids  in  the  defense  proc- 
ess really  succeed  in  repressing  anew  the  symp- 
toms of  the  return  of  the  memories  originally  re- 


THE  OBSESSIONAL  NEUROSIS  171 

pressed  by  the  ego,  then  the  obsession  is  trans- 
ferred to  the  protective  measures  themselves  and 
produces  a  third  form  of  obsessional  neurosis, 
the  obsessive  acts.  These  seem  to  be  seldom  \J 
primary;  they  never  contain  anything  except  a 
defense,  never  an  aggression.  Psycho-analysis 
demonstrates  that  in  spite  of  their  peculiarity 
and  diversity,  these  acts  in  every  case  may  be 
fully  explained  in  this  manner.  It  is  found  that 
these  obsessive  acts,  which  often  seem  so  silly  and 
senseless,  have  a  meaning  in  all  of  their  pecu- 
liarities without  exception;  they  serve  the  most 
vital  interests  of  the  personality  and  bring  to  ex- 
pression ^  experiences  which  are  still  active  as  well 
as  thoughts  tinged  with  affects  from  the  latter; 
this  is  effected  by  direct  or  symbolic  representa- 
tion. The  obsessive  acts  are,  therefore,  to  be  in- 
terpreted either  as  historical  or  symbolic. 

The  secondary  defense  of  the  obsessions  can  be 
accomphshed  by  a  strange  diversion  to  other  . 
thoughts  of  possibly  contrary  content;  hence  in  \J 
case  of  success,  the  obsessive  reasoning  is  regu- 
larly concerned  with  abstract  and  transcendental 
subjects,  because  the  repressed  ideas  always  oc- 
cupied themselves  with  sensuality.     Or  the  pa- 

2  According  to  a  later  statement  of  Freud's,  the  unconscious 
model  for  certain  obsessive  acts  which  is  always  imitated  in  the 
course  of  the  disease  may  be  the  original  sexual  act  which  was 
later  repressed.    Lit.  No.  36. 


172  FREUD'S  THEORY  OF  THE  NEUROSES 

tient  attempts  to  become  master  of  each  individual 
obsessive  idea  by  force  of  logic  and  appeal  to  his 
conscious  memories ;  this  leads  to  obsessive  think- 
ing, obsessive  testing  and  doubting  mania.  In 
these  testing  measures,  the  superior  power  of  the 
obsessive  idea  over  the  actual  memory  at  first 
impels  the  patient  and  later  compels  him  to  col- 
lect and  preserve  all  objects  with  which  he  comes 
in  contact.  The  frequently  grotesque  and  quite 
unintelligible  content  of  the  obsessions  is  made 
clear  by  the  explanation  that  these  ideas,  in  con- 
trast to  the  content  of  obsessional  acts  of  child- 
hood, are  distorted  in  a  twofold  manner:  (1)  An 
actual  occurrence  is  put  in  the  place  of  a  past  ex- 
perience; (2)  something  sexual  is  replaced  by 
something  analogous  non-sexual,  both  processes 
due  to  the  ever-present  tendency  to  repression. 
This  displacement  onto  another  idea  goes  forward 
only  gradually  as  the  idea  becomes  little  by  little 
more  disparate  and  unrecognizable.  The  obses- 
sion finally  appears,  devoid  of  motive  and  sense- 
less, quite  like  the  wording  of  our  nocturnal 
dreams,  and  the  first  task  which  it  imposes  is  to 
give  them  meaning  and  position  in  the  mental  life 
of  the  individual,  so  that  they  may  become  in- 
telligible and  indeed  even  obvious. 

The  secondary  defense  against  the  obsessive  af- 
fects develops  a  still  longer  series  of  protective 
measures,  which  are  readily  changeable  into  ob- 


THE  OBSESSIONAL  NEUROSIS  173 

sessive  acts.  These  can  be  grouped  according 
to  their  tendencies:  penitential  measures,  irksome 
ceremonials,  observation  of  numbers,  measures  of 
protection  (all  kinds  of  phobias,  superstitions, 
pedantry,  aggravation  of  primary  symptoms  of 
scrupulousness),  fear  of  betrayal  (paper-collect- 
ing, diffidence ) ,  narcotization  ( dipsomania ) . 
Among  these  obsessive  acts  and  impulses,  the 
phobias  play  the  greatest  role  in  restricting  the 
life  activities  of  the  patient.  The  phobias  which 
appear  in  the  course  of  an  obsessional  neurosis 
are  the  expression,  not  of  fears  but  of  prohibi- 
tions. 

To  give  a  systematic  and  well-rounded  exposi- 
tion of  the  obsessional  neurosis  on  the  basis  of 
Freud's  works  is  impossible;  only  recently,  his 
first  publication  has  been  succeeded  by  a  second 
which  brings  out  much  that  is  entirely  new  and 
valuable,  though  only  devoted  to  the  exposition 
of  a  single  case  of  severe  obsessional  neurosis 
without  pretending  to  have  elaborated  an  ex- 
haustive or  universally  applicable  theory  of  the 
subject.  For  a  presentation  which  is  intended  to 
be  merely  a  summary,  the  long  interval  between 
the  two  works  as  well  as  the  differences  in  their 
content  are  well  suited  to  illustrate  the  important 
progress  and  growing  depth  of  the  Freudian 
doctrines.     These  "Remarks  on  a  Case  of  Ob- 


174.  FREUD'S  THEORY  OF  THE  NEUROSES 

sessional  Neurosis"  ^  (1910)  give  extracts  from  a 
detailed  analysis  of  a  common  type  of  severe  ob- 
sessional neurosis  and,  in  accordance  with  the 
modern  status  of  the  theory,  trace  the  etiology 
in  widest  measure  to  infantile  sexual  life  and  in- 
stinct, at  the  same  time  showing  in  particular  the 
connection  of  the  obsessional  neurosis  to  the  sadis- 
tic component  of  the  sexual  instinct.  In  addi- 
tion, the  new  work  contains  statements  on  the 
genesis  and  finer  mental  mechanism  of  obsessive 
thought  in  general,  communications  which,  since 
they  bear  on  the  exposition  of  the  psycho-genesis 
of  the  obsessions  thus  far  given,  will  be  reviewed 
first. 

In  his  first  work,  Freud  had  defined  obsessions 
in  the  broadest  sense  collectively  in  the  following 
words:  they  are  in  every  case  transformed  re- 
proaches which  have  escaped  from  the  repression 
and  are  always  connected  with  some  pleasurably 
accomplished  sexual  act  of  childhood.  This  defi- 
nition is  not  discarded  in  the  later  work  but  the 
greatest  accent  is  placed  on  the  word  "trans- 
formed." Freud's  most  recent  work  now  goes 
into  the  manner  and  mechanism  of  this  trans- 
formation in  exhaustive  and  detailed  fashion  with 
special  attention  to  the  psychological  refinements 
in  the  formation  of  the  neurosis.  Freud  starts 
by  asserting  that  it  is  more  correct  to  speak  of 

3  Lit.  No.  36. 


THE  OBSESSIONAL  NEUROSIS  175 

obsessive  thinking  than  of  obsessive  ideas  ^(ob- 
sessions), at  the  same  time  emphasizing  the  fact 
that  the  obsessional  structure  may  have  the  value 
of  the  most  diverse  kinds  of  mental  processes. 
They  may  be  felt  as  wishes,  temptations,  im- 
pulses, reflections,  doubts,  commands  and  prohi- 
bitions. The  patients,  however,  strive  in  general 
to  weaken  this  definiteness  and  to  consider  the 
thought-content  robbed  of  its  affect-index  only  as 
a  mental  process,  as  an  obsession.  When  a  psy- 
cho-analyst comes  into  opposition  to  a  person  suf- 
fering from  such  an  obsessional  neurosis,  there 
appears  as  already  mentioned  the  paradoxical 
emotion  of  obsessive  force  attached  to  a  very  in- 
different content  and  it  is  only  after  much  effort 
that  he  succeeds  in  penetrating  to  the  original 
content  to  which  this  affect  rightly  belongs.  The 
mechanism  and  distortion  which  the  patient  has 
brought  into  use  in  this  defense  conflict  are  not  so 
simple  as  originally  thought.  The  value  of  the 
correctly  recognized  distinction  between  primary 
and  secondary  defense  conflict  becomes  limited  in 
an  unexpected  manner  by  the  discovery  that  the 
patients  for  the  most  part  do  not  know  the  word- 
ing of  their  obsessions  and  only  in  the  psycho- 
analytic treatment  become  aware  of  their  true 
meaning,  especially  by  the  aid  of  dreams.  Dur- 
ing the  analytic  investigation  of  the  patient's 
history,  the  conviction  is  forced  upon  one  that  the 


176     FREUD'S  THEORY  OF  THE  NEUROSES 

obsessions  which  appear  successively,  although 
not  expressed  in  identical  language,  are  at  bot- 
tom one  and  the  same.  The  obsession  which  has 
been  happily  gotten  rid  of  once  now  returns  again 
in  a  more  distorted  form.  The  original  form  is 
the  correct  one,  which  often  allows  its  meaning  to 
be  clearly  recognized.  After  one  has  patiently 
worked  out  an  unintelligible  obsessive  idea,  he 
often  hears  the  patient  say  that  such  a  tempta- 
tion, idea  or  wish  really  did  appear  at  one  time 
before  the  obsessive  idea,  but  did  not  remain. 
The  typical  characteristic  obsession  carries  thus  / 
in  its  distortion  against  its  original  wording  traces 
of  the  primary  defense  conflict.  The  distortion 
allows  them  to  find  expression  by  compelling  con- 
sciousness to  misunderstand  them,  just  as  the^ 
dream  content,  which  is  likewise  a  compromise  I 
and  distortion  product,  is  misunderstood  by  the 
waking  consciousness.* 

The  distortion  makes  use  of  various  mechan- 
isms. The  simplest  is  the  distortion  through 
ellipse,  which  finds  such  special  application  in 
wit,^  but  also  does  duty  in  the  neurosis  as  a  means 
of  protection  against  the  correct  recognition  of 
the  obsessive  idea.     One  of  the  favorite  obsessive 

4  This  misunderstanding  by  consciousness  is  observable  not  only 
in  the  obsessive  idea  itself  but  also  in  the  products  of  the  sec- 
ondary defense  conflict,  for  example,  in  the  protective  measures 

5  Compare  Freud's  "Der  Witz,  etc.,"  Lit.  No.  19. 


THE  OBSESSIONAL  NEUROSIS  177 

ideas  of  the  patient  whom  Freud  took  as  para- 
digma  in  his  publication  is  expressed  as  follows : 
"If  I  marry  Madame  X  misfortune  will  befall 
my  father  (in  the  other  world)."  If  we  insert 
the  connecting  links  which  are  omitted  in  this 
expression  and  only  brought  to  consciousness  by 
the  analysis,  the  train  of  thought  takes  a  more  in- 
telligible form:  "If  my  father  were  alive,  he 
would  become  greatly  enraged  over  my  intention 
of  marrying  Madame  X,  just  as  he  did  that  time 
he  flogged  me  as  a  child,  and  I  would  again  be 
angry  at  him  and  wish  him  all  evil,  which  the 
onmipotent  power  of  my  wishes  cannot  help 
bringing  to  fulfillment  upon  him."  This  ellipti- 
cal distortion  technique  seems  to  be  typical  for 
the  obsessional  neurosis.  Alongside  the  distor- 
tion which  the  obsessive  thought  has  undergone 
before  becoming  conscious,  there  is  seldom  lack- 
ing a  separation  of  the  individual  obsessive  idea 
from  the  occasion  of  its  origin  in  which  in  spite  of 
the  distortion  it  would  be  most  easily  accessible  to 
the  understanding.  In  furtherance  of  this  pur- 
pose, an  interval  is  interposed  between  the  path- 
ogenic occasion  and  the  resulting  obsessional  idea 
which  leads  consciousness  astray  in  its  search 
for  a  cause  and  correspondingly  disturbs  the  in- 
terpretation of  the  obsessional  idea  when  it  is 
again  attempted  to  ascertain  its  temporal  rela- 
tionship to  the  event  in  the  experience  of  the 


178  FREUD'S  THEORY  OF  THE  NEUROSES 

patient  by  discovering  when  the  individual  obses- 
sive idea  first  appeared  and  under  what  external 
circumstances  it  usually  reappears.  In  addition 
to  this  temporal  displacement,  the  content  of  the 
obsessive  idea  is  almost  regularly  freed  from  its 
special  relations  by  generalization.  In  this  con- 
nection, Freud  brings  forward,  as  an  example,  a 
patient  who  had  the  obsessive  prohibition  of  wear- 
ing any  jewehy  whatever,  although  the  occasion 
for  the  prohibition  went  back  to  a  particular  piece 
of  jewelry  which  she  had  envied  her  mother  and 
which  she  hoped  would  one  day  come  to  her  by 
inheritance.  A  further  frequent  characteristic 
of  the  mental  processes  of  the  obsessional  neuro- 
sis is  the  mechanism  of  displacement  which  Freud 
first  discovered  in  the  dream  formation  and  later 
proved  to  be  also  an  essential  factor  of  the  tech- 
nique of  wit.  Especially  in  the  obsessive  acts  is 
it  most  evident  how  by  a  displacement  from  the 
thing  of  real  importance  onto  a  substitute  of  little 
importance,  the  sjTiibolism  and  detail  of  the 
process  (the  ceremonial)  come  to  expression. 
It  is  this  tendency  to  displacement  which  is  con- 
stantly changing  the  chnical  picture  of  the  dis- 
ease and  finally  succeeds  in  making  the  appar- 
ently most  trivial  things  seem  the  weightiest  and 
most  urgent. 

Finally,  one  can  separate  from  the  distorted 
content  the  ambiguous  and  indefinite  wording 


THE  OBSESSIONAL  NEUROSIS  179 

which  serves  as  a  protection  of  the  obsessive  idea 
against  the  conscious  attempt  to.  solve  it.  The 
further  ampHfications  or  replacements  by  the  ob- 
sessive force  become  joined  to  this  misunderstood 
wording  instead  of  to  the  correct  context.  These 
processes,  in  contrast  to  the  distortion  technique 
of  the  content,  belong  to  the  secondary  defense 
conflict,  the  symptomatology  of  which  receives  a 
new  increase  from  the  so-called  deliria,  under 
which  term  Freud  places  mixed  conditions  be- 
tween purely  rational  considerations  and  the  ob- 
sessive thought  processes  to  which  these  are  op- 
posed; and  indeed  these  thoughts  do  incorporate 
some  of  the  presuppositions  of  the  obsession  which 
they  combat  and  by  the  aid  of  reason  take  their 
place  in  the  pathological  thought.  Into  these  de- 
liria also  enter  the  previouslymentioned  misun- 
derstandings ;  still,  it  can  be  observed  that  the  de- 
liria are  always  striving  to  gain  new  relations  to 
the  content  and  expression  of  the  obsession  which 
are  not  appreciated  by  consciousness.  In  the  re- 
cent description  of  the  secondary  defense  conflict, 
Freud  also  points  out  the  genesis  of  the  so- 
called  protective  obsession  which  signifies  noth- 
ing else  than  the  reaction,  repentance  and  peni- 
tence, to  an  opposite  impulse. 

The  obsessive  acts  often  show  an  alternating 
course  in  which  the  first  tempo  is  set  in  opposite 
to  the  second.     We  do  not  exactly  understand 


180  FREUD'S  THEORY  OF  THE  NEUROSES 

this  second  part  of  the  obsessive  act  if  we  consider 
it  only  as  a  critical  aversion  to  the  pathological 
act  which  he  would  like  to  give  up.  The  obses- 
sive acts  represent  the  conflict  of  two  impulses  of 
opposite  but  equal  value,  chiefly  the  opposition 
between  love  and  hate,  which  plays  a  great  role 
in  the  genesis  of  the  obsessional  neurosis  and  also 
finds  expression  in  its  symptoms.  These  alter- 
nating obsessive  acts  claim  an  especial  theoretical 
interest  because  they  disclose  a  new  type  of  symp- 
tom formation.  Instead  of  finding  a  compromise, 
as  regularly  happens  in  hysteria,  which  satis- 
fies both  opposing  forces  in  one  representation, 
the  two  opposing  forces  are  here  satisfied  indi- 
vidually, first  one,  then  the  other,  naturally  not 
without  the  attempt  being  made  to  produce  be- 
tween these  two  hostile  forces  a  kind  of  logical 
union,  often  with  the  destruction  of  all  logic. 

The  most  important  thing  in  the  new  work  of 
Freud's  on  the  obsessional  neurosis  is,  as  men- 
tioned, the  proof  of  the  fundamental  significance 
of  original  instinct.  Characteristic  of  a  later  ob- 
sessional neurosis  is  the  appearance  of  a  special 
aggression  and  activity  in  childhood  which  ex- 
presses itself  chiefly  in  an  intensive  activity  of  the 
impulse  to  peek  (Schautrieb)  and  to  know 
(Wisstrieb).  Instinct  has  been  especially 
abundant  and  powerful  in  childhood  and  succeeds 
in  being  of  extraordinary  significance  in  the  gene- 


THE  OBSESSIONAL  NEUROSIS  181 

sis  of  the  obsessional  neurosis  through  the  most 
intensive  elaboration  of  the  emotions  of  affection 
and  hostility  toward  the  parents,^  brothers  and 
sisters  which,  in  conjunction  with  infantile  sexual 
curiosity  regarding  sex  and  birth  processes,  forms 
the  nuclear-complex  of  the  neurosis.  We  find, 
however,  in  the  symptomatology  of  the  obses- 
sional neurosis  a  continual  conflict  between  love 
and  hate,  a  chronic  existence  side  by  side  of  these 
two  feelings  toward  the  same  person  and  indeed 
both  emotions  in  highest  intensity,  a  phenomenon 
which  is  calculated  to  astonish  us  when  we  always 
find  it  in  these  patients.  Such  a  continuance  of 
contrasts  is  possible  only  under  peculiar  psycho- 
logical conditions  and  through  the  cooperation  of 
the  unconscious  condition.  Love  has  not  extin- 
guished hate  but  only  succeeded  in  repressing  it 
into  the  imconscious,  where,  protected  from  elimi- 
nation through  the  aid  of  consciousness,  it  can 
exist  and  even  grow.  Under  these  conditions, 
conscious  love  attempts  by  way  of  reaction  to  ex- 
pand to  an  especially  high  intensity  in  order  that 
it  may  meet  the  constantly  imposed  task  of  hold- 
ing its  opponent  in  repression.  A  very  early 
separation  of  these  two  opposing  feelings  occur- 
ring in  the  earliest  years  of  childhood,  with  the  re- 
pression of  one  of  them,  commonly  hate,  seems 
to  be  the  foundation  of  this  strange  constellation 

« Compare  the  already  mentioned  "ddipuscomplex." 


182  FREUD'S  THEORY  OF  THE  NEUROSES 

of  the  life  of  love.  Although  the  connection  be- 
tween the  negative  factor  of  love  to  the  sadistic 
component  of  the  sexual  instinct  is  not  explained, 
Freud  believes  that  he  can  give  out  the  pro- 
visional opinion  that  in  these  cases  of  unconscious 
hate,  the  sadistic  component  of  love  may  have 
been  especially  strongly  developed  constitution- 
ally and  have  received  a  premature  and  all  too 
profound  suppression;  thus,  the  phenomena  of 
the  neurosis  are  derived,  on  the  one  hand,  from 
conscious  affection  highly  developed  as  a  re- 
action; on  the  other  hand  from  the  sadism 
continually  active  in  the  unconscious/  This 
sort  of  constitutional  hate  component  is  acci- 
dentally supported  by  the  traumata  received 
from  prohibitions  imposed  mostly  by  the  parents 
(father)  which  attain  a  great  significance  in  the 
genesis  of  the  obsessional  neurosis.  Thus,  a 
vigorous  punishment  on  account  of  sexual  activity 
or  childhood  fault  in  connection  with  this,  be- 
comes a  strong  supporting  measure  of  the  hate 
which  originally  sprang  from  the  parent-com- 
plex. The  occasion  for  such  punishment  soon 
arises  for  a  definite  type  of  patient  who  is  later 
aflSicted  with  an  obsessional  neurosis,  shows  even 

7  This  connection  also  explains  the  frequent  and  enigmatical 
obsessional  laughing  on  occasions  of  sorrow  which  betrays  the 
unconscious  joy  at  the  suffering  or  downfall  of  the  unconsciously 
hated  person. 


THE  OBSESSIONAL  NEUROSIS  183 

in  childhood  voluptuous  wishes  to  which,  of 
course,  uncomfortable  expectations  and  tend- 
encies to  protective  acts  are  joined.  Thus,  a  con- 
flict is  present  in  the  mental  life  of  these  little 
voluptuaries;  beside  the  obsessional  wish  stands 
an  obsessional  fear  intimately  connected  with 
the  wish.  Thus,  a  sexual  instinct  and  a  rebellion 
against  it,  a  wish  (not  yet  obsessive)  and  fear  (al- 
ready obsessive)  striving  against  it,  a  painful 
affect  and  the  compulsion  toward  protective  acts, 
the  inventory  of  the  neurosis  is  complete.  This 
infantile  preliminary  stage  of  the  neurosis  is 
regularly  present  and  often  becomes  manifest  in 
the  child  as  disease.^ 

The  next  result  of  this  noteworthy  connection 
between  love  and  hate  which  is  demonstrable  in 
every  case  of  obsessional  neurosis,  is  a  partial 
weakening  of  the  will,  an  incapacity  for  resolu- 
tion in  all  actions  for  which  love  should  be  the 
compelhng  motive.  The  irresolution,  however, 
does  not  long  remain  limited  to  this  group  of  acts, 
but,  by  means  of  the  already  mentioned  mechan- 
ism of  displacement,  gradually  spreads  over  the 
whole  range  of  the  person's  activity.  Thereby 
is  created  the  sway  of  obsession  and  doubt  as  it 
is  exhibited  in  the  mental  life  of  the  obsessional 
patients.     The  doubt  corresponds  to  the  inner 

8  Thus  beside  the  anxiety-hysteria,  the  obsessional  neurosis  is  a 
second  type  of  neurosis  of  childhood. 


184  FREUD'S  THEORY  OF  THE  NEUROSES 

appreciation  of  the  irresolution  which  as  a  result 
of  the  inhibition  of  love  by  hate  takes  possession 
of  every  voluntary  act  of  the  patient  and  can 
spread  further  to  all  acts,  those  already  com- 
pleted, those  not  yet  related  to  the  love-hate  com- 
plex and  to  the  whole  past.  This  is  really  the 
doubt  of  the  power  to  love  which  should  be  sub- 
jectively the  greatest  certainty.  It  is  the  same 
doubt  which,  in  protective  measures,  leads  to  un- 
certainty and  continual  repetition  which  finally 
makes  these  protective  acts  become  as  impossible 
of  attainment  as  the  original  inhibited  love  resolu- 
tion. The  uncertainty  of  the  patients  finds  ex- 
pression also,  for  example,  in  their  prayers  im- 
ploring the  sparing  of  the  life  of  another  which 
unconscious  phantasies  incessantly  interrupt ; 
I  these  phantasies  contain  for  the  most  part  the  im- 

^  pulse  which  is  in  direct  contradiction  to  the  peti- 

tion voiced  in  the  prayer. 

The  obsession  becomes  now  a  ''search  for  the 
compensation  for  the  doubt"  and  for  a  correction 
of  the  unbearable  states  of  inhibition  to  which  the 
doubt  refers.  If  the  patient,  by  the  aid  of  the 
displacement,  has  succeeded  in  bringing  any  one 
of  the  inhibited  intentions  to  a  decision,  this  de- 
mands immediate  execution;  it  is  indeed  no 
longer  the  original  energy  belonging  to  the  in- 
tention but  the  pent-up  energy  which  now  finds 
occasion  to  escape  by  the  substitute  act.    It  thus 


THE  OBSESSIONAL  NEUROSIS  185 

finds  expression  in  commands  and  prohibitions 
according  as  it  is  now  the  affectionate,  now  the 
hostile  impulse  which  gains  the  way  of  escape. 

By  a  kind  of  regression,  further  preparatory 
acts  take  the  place  of  the  final  resolution,  thought 
replaces  action  and  some  sort  of  mental  prepara- 
tion for  the  act  is  carried  out  by  obsessive  force 
instead  of  the  substitute  act  itself.  According 
as  this  regression  from  motor  function  to  idea- 
tional is  more  or  less  complete,  the  case  of  obses- 
sional neurosis  assumes  the  character  of  obsessive 
thinking  (obsession)  or  obsessive  act  in  the  nar- 
rower sense.  The  point  in  question  is  in  what 
stage  of  the  continual  progress  of  the  defense 
conflict  the  breaking  through  of  the  repressed  in- 
stinct takes  place  and  which  impulse  is  in  control. 
This  acceptance  of  a  thought  as  a  substitute  for 
an  impulsive  act  makes  possible  the  following 
formula  for  the  psychological  characteristic  which 
gives  the  products  of  the  disease  its  obsessional 
attribute:  those  processes  tend  to  become  obses- 
sions which,  on  account  of  an  opposing  inhibition 
at  the  motor  end  of  the  nervous  system,  have 
taken  to  themselves  a  fund  of  energy  of  a  quality 
and  quantity  otherwise  used  only  for  motor  func- 
tions, that  is  to  say,  thoughts  which  necessarily 
represent  regressive  acts. 

This  displacement  of  the  accent  from  the  motor 
process  to  the  thought  process  shows  the  obses- 


186     FREUD'S  THEORY  OF  THE  NEUROSES 

sional  neurosis  to  be  in  general  a  misuse  of  think- 
ing. The  pathological  exaggerations  of  the  ob- 
sessional neurosis,  if  investigated  more  closely, 
might  afford  great  profit  for  the  understanding 
of  the  intellectual  life  in  general.  In  this  way, 
Freud  was  able  to  derive  something  typical  from 
the  mental  peculiarities  of  his  case.  Thus,  the 
peculiar  relation  to  superstition,  death  and 
reality,  which  is  different  in  those  suffering  from 
obsessional  neurosis.  These  peculiarities  have 
their  ultimate  foundation  for  the  most  part  in 
instinct.  Especially  does  the  strange  conduct  to- 
ward the  subject  of  death  and  the  intensive  occu- 
pation with  this  problem  attract  the  attention  of 
the  physician.  Those  obsessed  often  sympathize 
warmly  in  all  cases  of  death  and  piously  take 
part  in  the  funerals.  This  strange  characteristic 
of  the  patients  rests  on  the  fact  that  as  children 
they  came  into  contact  with  the  problem  of  death 
through  their  evil,  vengeful  wishes ;  as  compensa- 
tion for  this,  there  then  appears  their  intellectual 
and  emotional  occupation  with  this  subject,  thus 
this  complex  is  also  a  root  of  their  phantasies  of 
the  future  life  (superstition).  Their  supersti- 
tious tendencies  have  for  the  most  part  abso- 
lutely no  other  content  and  in  general  have  per- 
haps no  other  origin.  Before  all,  however,  and 
here  we  touch  on  one  of  the  motives  for  the  illness, 
they  need  the  possibiHty  of  death  as  a  solution  of 


THE  OBSESSIONAL  NEUROSIS  187 

the  mental  conflicts  which  they  find  insoluble  by 
themselves.  Their  essential  characteristic  is  in- 
deed that  they  are  incapable  of  decision,  espe- 
cially in  matters  of  love.  Thus,  in  every  life 
conflict,  they  look  for  the  death  of  one  who  is 
important  to  them,  usually  of  a  loved  one,  it  may 
be  a  parent,  a  rival  or  a  lover,  between  whom  their 
affection  wavers. 

Through  the  overvaluation  of  the  product  of 
their  mental  processes,  for  example,  the  pos- 
sibility of  causing  death  by  their  thoughts 
(wishes),  such  obsessed  patients  gradually  come 
to  believe  in  the  omnipotence  of  their  thoughts. 
On  the  one  hand,  there  is  also  in  this  belief  a  piece 
of  the  old  childish  delusion  of  grandeur.  An- 
;other  mental  need  which  has  a  certain  relation- 
ship to  the  one  already  mentioned  is  that  of  un- 
icertainty  in  life  or  doubt.  The  bringing  about 
of  uncertainty  is  one  of  the  methods  which  the 
neurosis  adopts  to  draw  the  patient  away  from 
reality,  to  isolate  him  from  the  world,  which  is 
indeed  the  tendency  of  every  psycho-neurotic 
disturbance.  The  predilection  of  the  patients  for 
Uncertainty  and  doubt  becomes  a  motive  for  them 
to  fasten  their  thoughts  chiefly  on  those  subjects 
ivhere  uncertainty  is  common  to  all  the  race  and 
where  our  knowledge  or  our  judgment  must 
necessarily  remain  exposed  to  doubt.  Such  sub- 
jects in  particular  as  paternal  parentage,  dura- 


188     FREUD'S  THEORY  OF  THE  NEUROSES 

tion  of  life,  life  after  death  and  the  reliability  of 
memory. 

An  especially  strange  trait  of  a  patient  with 
obsessional  neurosis  who  has  otherwise  a  fairly 
high  degree  of  intelligence,  is  the  above  mentioned 
superstitiousness.  This  belongs  to  their  suffer- 
ings but  not  to  their  personality;  it  does  not  in- 
deed permeate  all  their  thought.  The  patient 
may  be  superstitious  during  the  illness  but  other- 
wise enlightened  and  a  freethinker.  In  this  con- 
nection, they  often  have  two  opposed  convictions, 
not  one  incomplete  opinion.  Between  these  two 
convictions,  they  oscillate  in  the  most  obvious  pro- 
portion to  their  suflfering.  This  superstition  is 
thus  no  real  conviction  with  the  patients  but  has 
an  obsessive  character.  From  the  analysis  of 
cases  of  obsessional  neurosis,  a  deep  insight  into 
the  psychology  of  superstition  may  be  gained;  it 
can  here  be  recognized  that  superstition  springs 
from  suppressed  hostile  and  cruel  impulses. 
Superstition  is  in  great  part  expectation  of  mis- 
fortune, and  he  who  has  frequently  wished  an- 
other evil,  but  on  account  of  being  trained  to 
kindness  has  repressed  such  wishes  into  the  uncon- 
scious, will  find  it  especially  easy  to  anticipate 
misfortune  threatening  him  from  without  as 
punishment  for  such  unconscious  wickedness. 


CHAPTER  VIII 

PSYCHO-ANALYTIC   METHOD   OF  INVESTIGATION 
AND   TREATMENT 

Its  Peculiarity  (Specific  Therapy).  History  of  the 
Development  of  the  Method.  General  Technique.  Art 
of  Interpretation*  Indications  and  Contraindications. 
The  Transference.  Refutation  of  the  Objections  to 
the  Method. 

Freud  has  expressed  himself  repeatedly  both 
orally  and  in  writing  concerning  his  psycho- 
analytic technique,  which  has  completely  replaced 
the  original  cathartic  and  hypnotic  methods; 
nevertheless,  there  is  stiU  lacking  a  detailed  and 
systematic  representation  especially  of  the  tech- 
nical rules  and  devices  founded  on  painstaking 
empiric  procedure.  In  spite  of  this,  a  number  of 
students  and  adherents,  who  in  great  part  are  in 
close  touch  with  Professor  Freud,  practice  the 
therapy  according  to  his  directions  and  their  own 
auto-didactic  studies  and  experiments.  In  the 
hands  of  a  physician  not  sufficiently  versed  in  the 
subject,  the  therapy  can  easily  work  harm.  Psy- 
chotherapy of  other  kinds  has  nothing  in  common 

isa 


190     FREUD'S  THEORY  OF  THE  NEUROSES 

with  psycho-analysis,  which  differs  from  hypnosis 
as  well  as  every  kind  of  suggestion  and  utilizes 
the  associations  as  well  as  the  dreams  of  the  pa- 
tient to  lay  bare  his  unconscious.  Psycho-analy- 
sis proceeds  from  the  "psychic  surface"  and  seeks 
from  there  in  narrative-like  penetration  to  set 
free  the  repressed  complexes  and  thereby  the  in- 
stinctive impulses.  TKiesugeriority  of  this  over 
the  methods  of  treatment  ^reyiousfy^  used  in  the 
treatment  of  nervous  disorders  shows  best  in  the 
fact  that  while  acting  as  a  specific,  it  reveals  the 
etiology  of  the  case.  Thus  it  is  to  be  (considered 
as  theoretically  the  ideal  psychotherapy  of  psy- 
chogenic maladies.  Freud  does  not  mean  at  all 
that  it  is  always  and  in  all  cases  and  under  all 
conditions  the  only  possible  or  necessary  therapy 
and  has  never  asserted  that  all  cases  of  neurosis 
are  therapeutically  accessible  or  that  all  can  be 
cured.  The  psycho-anal^'^tic^therapy  is,  bqw- 
ever,_shown  by  experience^  to  work  thejmost  im- 
pressively, carry  the  farthest  and  accomplisli  the 
most  inten^e_changes  in  the  patients.  Quite 
apart  from  the  therapeutic  view-polntTwe  are  in- 
djebtedto  this  irreplaceable  niethod  for  such  unex- 
pected^enlipitSmi  on  the  theory  of  ITie  neu- 
roses as  more  than  compensates  for  the  only  oc- 
casional bad  result  which  no  therapy  escapes.  In 
any  case,  psycho-anaiysis"is  the  most  interesting 
of  all  psychotherapies  because  it  alone  teaches  us. 


PSYCHO-ANALYTIC  METHOD  191 

something  of  the  origin  and  relations  of  the  dis- 
ease manifestations^  As  a  result  of  the  insight 
into  the  mental  mechanism  of  mental  diseases 
which  it  opens  to  us,  it  alone  is  in  a  position  to 
lead  us  on  and  show  us  the  way  to  still  other  kinds 
of  therapeutic  influences. 

The  particular  method  of  psychotherapy  * 
which  Freud  practices  and  calls  psycho-analysis 
has  come  from  the  so-called  cathartic  method  on 
which  he  at  one  time  collaborated  with  J.  Breuer 
in  a  book  ''Studien  iiber  Hysteric."  The  cathar- 
tic therapy  was  a  discovery  of  Breuer's  by  the 
aid  of  which  he  had,  about  a  decade  previously, 
restored  an  hysterical  patient  to  health,  thereby 
gaining  an  insight  into  the  pathogenesis  of  her 
symptoms.  At  the  personal  suggestion  of 
Breuer,  Freud  then  took  up  the  method  and 
tested  it  on  a  large  number  of  patients. 

The  cathartic  method  presupposed  that  the  pa- 
tient is  hypnotizable  and  rested  on  the  extension 
of  consciousness  which  appeared  in  hypnosis. 
He  set  up  as  a  goal  the  removal  of  the  disease 
symptom  and  attained  this  by  transferring  the 
patient  back  to  the  mental  state  in  which  the 
symptom  first  appeared.     Then  there  came  to  the 

iThe  following  review  of  "Freudsche  psychoanalytische 
Methode"  is  in  some  points  an  enlarged  repetition  of  the  article 
of  Freud's  by  the  same  name.    Lit.  No.  18. 


192     FREUD^S  THEORY  OF  THE  NEUROSES 

hypnotized  patient  memories,  thoughts  and  im- 
pulses which  had  previously  escaped  from  con- 
sciousness and  if  he  communicated  these  mental 
processes  under  intense  expressions  of  affect  to 
the  physician,  the  symptom  was  overcome  and  its 
return  prevented.  This  apparently  regularly 
recurring  experience  the  two  authors  explained 
in  their  book  by  the  fact  that  the  symptoms  stood 
in  place  of  suppressed  psychic  processes  which 
could  not  appear  in  consciousness,  thus  repre- 
sented a  change  ("conversion")  of  the  latter. 
The  therapeutic  efficacy  of  their  method  they  ex- 
plained as  a  discharge  of  an  affect  dammed  up, 
as  it  were,  which  had  remained  from  the  sup- 
pressed mental  processes  (abreaction,  Abre- 
agieren) .  This  simple  scheme  of  therapeutic  at- 
tack was  complicated  nearly  all  the  time,  how- 
ever, by  the  fact  that  not  a  single  **traumatic" 
impression  but  usually  a  complex  series  of  such 
impressions  shared  in  the  origin  of  the  symptom. 

The  chief  characteristic  of  the  cathartic 
method,  which  puts  it  in  contrast  to  all  other 
methods  of  psychotherapy,  lies  in  the  fact  that  in 
this  procedure  the  therapeutic  efficiency  does  not 
depend  on  a  suggestive  conmiand  of  the  phys- 
ician. It  anticipates  rather  that  the  symptoms 
will  disappear  if  the  attempt,  which  appeals  to 
certain  presuppositions,  concerning  the  mental 
mechanism,  succeeds  in  bringing  the  mental  proc- 


PSYCHO-ANALYTIC  METHOD  193 

esses  into  different  channels  than  they  have 
previously  followed  in  the  formation  of  symp- 
toms. 

The  modifications  of  the  cathartic  method  im- 
dertaken  were  at  first  changes  in  the  technique; 
these  brought  new  results  and  have  necessitated 
a  different  though  not  contradictory  conception 
of  the  therapeutic  work. 

As  the  cathartic  method  had  already  aban- 
doned suggestion,  so  Freud  took  the  further  step 
of  also  giving  up  hypnosis.  Since  the  hypnotiza- 
tion,  in  spite  of  every  skill  of  the  physician,  inter- 
feres, as  is  known,  with  the  free  will  of  the  pa- 
tient and  a  great  number  of  neurotic  persons  can-  ^ 
not  be  hypnotized  by  any  method,  thus  through 
the  abandonment  of  hypnosis,  the  applicability  of 
the  method  was  extended  to  an  unlimited  number 
of  patients.  On  the  other  hand,  the  extension  of 
consciousness  was  omitted  which  had  furnished 
the  physician  just  that  psychic  material  in  memo- 
ries and  ideas  by  the  help  of  which  the  transposi- 
tion of  the  symptoms  and  the  freeing  of  the  af- 
fect was  accomplished.  If  no  substitute  were  to 
be  provided  for  this  deficiency  there  could  be  no 
such  thing  as  therapeutic  influence. 

Such  an  entirely  sufficient  substitute,  Freud 
found  in  the  associations  of  the  patient,  that  is, 
in  the  involuntary  thoughts  which  are  mostly  per- 
ceived as  disturbing  ones  and  therefore  under 


194     FREUD'S  THEORY  OF  THE  NEUROSES 

ordinary  circumstances  disregarded;  these  invol- 
untarily press  to  the  psychic  surface  in  the  "re- 
cital" of  the  patient  to  the  physician  and  betray 
the  disease  complex.^  Thus,  at  that  time  the 
work  proceeded  from  the  symptoms  and  set  up 
the  solution  of  the  same  serially  as  a  goal;  Freud 
has  since  given  up  this  method  because  he  found 
it  entirely  unsuited  to  the  finer  structure  of  the 
neurosis.  He  now  allows  the  patient  himself  to 
determine  the  theme  of  the  daily  work  and  by 
this  means  proceeds  from  the  complex  which  is 
present  in  the  foreground  of  the  patient's  mind. 
Thus,  one  receives  all  kinds  of  material  which 
belongs  to  a  solution  of  the  symptom,  broken  into 
fragments,  interwoven  in  different  connections 
and  distributed  over  widely  separated  periods  of 
time;  in  spite  of  this  apparent  disadvantage  the 
new  technique  far  surpasses  the  old. 

In  order  to  strengthen  these  associations, 
Freud  uses  the  following  outside  means  of  assist- 
ance. He  has  the  patient  rechne  comfortably 
on  a  couch  while  he  sits  on  a  chair  behind  and 
out  of  his  line  of  vision.  He  does  not  insist  upon 
the  eyes  being  closed  and  avoids  any  touch  as  well 
as  every  other  procedure  which  might  lead  to 

2  The  experimental  confirmation  of  this  presupposition  of  the 
Freudian  method  of  treatment  has,  as  already  mentioned,  been 
afforded  by  the  association  experiments  undertaken  by  the  Zurich 
school  which  many  psycho-analysts  use  to  gain  associations  from 
patients. 


PSYCHO-ANALYTIC  METHOD  195 

hypnosis.  Such  a  seance  goes  along  like  a  con- 
versation between  two  similarly  awake  persons  of 
whom  one  is  relieved  of  every  muscular  tension 
and  every  distracting  sense  impression  which 
might  disturb  the  concentration  of  the  attention 
upon  his  own  mental  affairs.  Before  he  proceeds 
to  details,  he  urges  them  often  for  several  sessions 
to  sketch  a  general  picture  of  their  whole  illness 
and  most  intimate  family  and  life  surroundings,^ 
to  tell  him  everything  which  comes  into  their 
heads  whether  they  think  it  important,  irrelevant 
or  nonsensical.  With  special  emphasis,  it  is 
asked  of  them  that  no  thought  or  association  be 
omitted  from  the  communication  because  this 
telling  might  be  shameful  or  painful.  In  taking 
pains  to  collect^  this  material  from  associations 
which  would  otherwise  have  been  pushed  aside, 
Freud  now  made  the  observations  which  have  be- 
come determining  for  his  whole  conception.  Al- 
ready in  this  narration  of  the  patient's  history, 
there  appear  defects  of  memory;  perhaps  actual 
occurrences  are  forgotten  or  temporal  relations 

8  It  is  not  recommended  that  the  psycho-analyst  undertake  an 
investigation  of  the  somatic  conditions  himself  but  where  possible 
to  have  this  done  by  a  specialist  in  that  line. 

*  Freud  warns  expressly  against  taking  up  the  time  of  the 
treatment  itself  with  making  notes  of  the  conversation  of  the 
patient  because  this  would  awaken  a  mistrust  on  the  patient's 
part  and  confuse  the  physician  in  the  appreciation  of  the  material 
produced.    Notes  made  afterwards  are  nevertheless  indispensable. 


196     FREUD'S  THEORY  OF  THE  NEUROSES 

twisted  or  causal  relations  distorted  so  that  in- 
comprehensible effects  result.  No  neurotic  clin- 
ical history  is  free  from  amnesia  of  some  kind. 
The  psycho-analyst  can  only  wonder  how  the 
smooth  and  exact  clinical  histories  of  hysterical 
cases  are  produced  by  other  authors.  Only  in 
the  course  of  the  treatment  does  the  patient  bring 
forth  what  he  has  held  back  or  what  has  not  oc- 
curred to  him,  although  he  has  always  known  it. 
When  one  urges  the  narrator  to  fill  in  these 
breaks  in  his  memory  by  concentrated  attention, 
one  discovers  that  the  interrupted  associations 
are  held  back  from  him  by  all  the  means  of 
critique  until  the  patient  finally  feels  direct  dis- 
comfort if  the  memory  has  really  stopped. 
From  this  experience,  Freud  concluded  that  the 
amnesias  are  the  result  of  the  process  which 
he  has  described  as  repression  (Verdrangung). 
The  psychic  forces  which  have  caused  this  repres- 
sion are  to  be  detected  in  the  resistance  which  sets 
itself  against  the  revival  of  the  memories.  To 
seek  out  and  overcome  these  resistances  is  the 
most  important  part  of  the  therapeutic  work. 

The  agency  of  the  resistance  has  become  one 
of  the  fundamentals  of  the  Freudian  theory.  He 
considers  the  associations  side-tracked  under  all 
sorts  of  pretexts,  as  descendants  of  the  repressed 
psychic  structures  (thoughts  and  emotions),  as 
distortions  of  the  same  by  the  opposition  of  the 


PSYCHO-ANALYTIC  METHOD  197 

resistance  against  their  reproduction.  Further, 
the  associations  of  the  patient  are  quasi-symp- 
toms,  new,  artificial  and  ephemeral  substitutions 
for  the  repressed  material  but  already  so  much 
distorted  that  they  have  only  the  remotest  re- 
semblance to  the  repressed  material.  If  the  re- 
sistance is  not  too  intense,  it  may  be  possible  to 
guess  from  the  association  the  desired  concealed 
material.  The  greater  the  resistance,  the  more 
pronounced  the  distortion.  In  this  relation  of 
the  undirected  associations  to  the  repressed 
psychic  material,  rests  its  value  for  the  thera- 
peutic technique.  If  one  possesses  a  method 
which  renders  it  possible  to  discover  the  repressed 
material  from  the  associations,  the  things  dis- 
torted from  the  original,  then  one  can,  with- 
out hypnosis,  make  attainable  to  consciousness 
the  earlier  unconscious  material  in  the  mental 
life. 

In  this  regard,  Freud  has  elaborated  an  inter- 
pretation technique  that  accomplishes  this  task; 
this  might  be  described  as  recovering  from  the 
ore  of  unguided  associations  the  mental  content 
of  repressed  thoughts.  The  objects  of  this  inter- 
pretation technique  are  not  merely  the  associa- 
tions of  the  patient  but  also  his  dreams  which 
afford^  the  most  direct  entrance  to  the  uncon- 

5  Freud  shows  the  value  of  the  technique  of  dream  interpreta- 
tion in  the  psycho-analytic  treatment  in  a  book  entitled  "Bruch- 


198     FREUD'S  THEORY  OF  THE  NEUROSES 

scious,  his  unintentional  acts  such  as  aimless  acts 
(symptomatic  acts)  and  the  mistakes  ^  of  his  per* 
formances  in  everyday  life  (misstatements,  mis- 
understandings, etc.).  According  to  Freud, 
there  is  a  series  of  empiric  rules  which  enable  the 
analyst  to  construct  the  unconscious  material 
from  the  associations  of  the  patient ;  instructions 
concerning  what  one  is  to  understand  if  the  asso- 
ciations of  the  patient  contradict  and  examples 
of  the  most  important  typical  resistances  which 
appear  in  the  course  of  such  a  treatment. 

Although  as  yet  Freud  has  pubhshed  no  col- 
lected representation  "^  of  the  details  of  this  inter- 
pretation and  translation  technique,  still  there  are  \ 
in  his  "Bruchstiick  einer  Hysterieanalyse"  ^  some 
preliminary  references  to  the  overcoming  of  cer- 
tain difficulties  which  appear  regularly  in  every 
psycho-analytic  treatment ;  these  may  be  removed 
only  by  an  exact  knowledge  of  their  psychic  mo- 
stuck  einer  Hysterieanalyse"  (Lit.  No.  31).  One  must  not  ex- 
pect that  every  dream  right  at  the  beginning  of  the  treatment  may 
be  completely  interpreted  before  one  is  oriented  in  relation  to 
the  most  important  complexes  of  the  patient. 

©The  interpretation  technique  of  mistakes  is  in  "Psycho- 
pathologie  des  Alltagslebens,"  Lit.  No.  16. 

7  The  comprehensive  work  on  dream  interpretation  ("Traum- 
deutung")  is  to  be  considered  a  precursor  to  such  an  introduc- 
tion to  the  technique. 

8  Those  of  the  following  rules  which  are  not  derived  from  this 
analysis  are  taken  from  Freud's  lectures  on  "Methodik  der 
Psychotherapie"  delivered  in  the  winter  semester  1908,  the  publi- 
cation of  which  is  in  preparation. 


PSYCHO-ANALYTIC  METHOD  199 

\tives  and  the  communication  of  this  to  the  pa- 
Itient. 

'  If  it  would  seem  at  first  that  one  might  rely 
on  the  flow  of  associations,  on  the  interpretation 
of  which  the  treatment  depends,  even  a  short  in- 
vestigation teaches  every  time  that,  as  it  lies  in 
the  nature  of  the  whole  method  of  treatment  and 
its  presuppositions,  the  analysis  is  often  inter- 
rupted by  the  resistances  combating  the  laying 
bare  of  the  repressions.  The  removal,  that  is, 
the  exposing  of  these  resistances,  is  the  chief  task 
of  the  technique;  after  this  has  been  accom- 
plished, the  material  necessary  for  the  uncover- 
ing of  the  complexes  reveals  itself.  The  physi- 
cian must  be  prepared  for  these  resistances  which 
clothe  themselves  in  the  most  varied  forms  and 
lead  to  pauses  in  the  associations  of  the  patient. 
The  pauses  have,  as  experience  gained  from 
numerous  analyses  shows,  certain  typical  and,  for 
the  skillful  physician,  readily  transparent  causes. 
Thus,  a  gross  sexual  memory,  the  communication 
of  which  to  the  physician  may  be  withheld  con- 
trary to  the  conditions  of  the  treatment,  keeps 
constantly  recurring  to  the  patient  against  his 
will  and  regularly  leads  to  such  a  break  in  the 
associations.  Similarly,  works  a  disturbance  of 
the  relation  to  the  physician:  it  may  be  the  feel- 
ing of  an  especially  intense  antipathy  or  sym- 
pathy which  will  not  be  betrayed  by  the  patient. 


200     FREUD'S  THEORY  OF  THE  NEUROSES 

Further,  the  material  side  of  the  treatment,  an 
impatience  over  a  relatively  long  duration  of  the 
treatment  can  interrupt  the  flow  of  associations. 
The  resistance  also  frequently  expresses  itself  in 
the  fact  that  the  otherwise  copious  dream  reports 
stop  or  flow  in  such  fullness  and  extent  that  the 
placing  of  them  in  the  framework  of  the  treat- 
ment becomes  impossible.  The  skillful  psycho- 
analyst will  explain  to  the  patient  how  the  re- 
sistance stands  in  the  way  and  the  motive  for  his 
denial  of  associations  from  case  to  case  whereby 
the  analysis  can  almost  always  proceed  more 
rapidly  since  every  time,  through  the  elimination 
of  the  resistance,  the  entrance  to  new  imconscious 
material  becomes  free  which  this  resistance  really 
only  serves  to  conceal. 

As  already  described,  besides  the  associations 
and  dreams  of  the  patient,  the  so-called  symp- 
tomatic acts  have  great  importance  for  the  ex- 
planation of  the  unconscious  mental  life.  Under 
this  term  Freud  understands  those  actions  which 
a  person  carries  out  as  they  say  "automatically, 
unconsciously,  without  thinking  about  them,  as  if 
playing,"  to  which  they  would  deny  any  signifi- 
cance and  if  questioned  about  them  explain  as  in- 
different and  accidental.  Careful  observation 
shows  that  such  acts,  of  which  consciousness 
knows  nothing  or  wishes  to  know  nothing,  give 
expression  to  unconscious  thoughts  and  impulses 


PSYCHO-ANALYTIC  METHOD  201 

which  are  valuable  and  illuminating  as  unpermit- 
ted expressions  of  the  unconscious.  Besides  the 
unlimited  number  of  possibilities  for  individual 
and  specific  symptomatic  acts  ^  certain  typical 
forms  regularly  take  a  hand  in  the  psycho-anal- 
ysis. Thus,  the  patient's  tardiness  in  coming  to 
the  treatment  often  indicates  a  secret  resistance 
against  his  coming  on  this  day ;  still  more  clearly 
does  the  remaining  entirely  away  from  the  ap- 
pointment speak  for  an  ordinarily  very  weakly 
motivated  ground  for  the  prevailing  powerful  re- 
sistance. Just  as  important  as  symptomatic  acts 
are  all  those  first  communications  of  the  patient 
especially  at  the  beginning  of  the  treatment  and 
also  the  first  expressions  sometimes  made  at  the 
beginning  of  each  consultation  hour.  In  similar 
indirect  manner  as  the  patient  communicates  to 
the  physician  by  means  of  symptomatic  acts,  the 
direct  expression  of  which  is  not  possible  or  pain- 
ful to  him,  so  also  the  next  dream  may  bring  to 
expression  the  same  material  in  veiled  terms. 

Besides  these  aphoristic  communications  of  a 
general  nature,  Freud  has  given  in  their  practical 
application,  in  his  published  pamphlet  on  an  anal- 
ysis of  a  case  of  hysteria,  some  of  the  rules  of  in- 
terpretation gained  empirically.     Especially  in 

» Examples  of  these  may  be  found  in  "BruchstUck  einer 
Hysterieanalyse"  as  well  as  in  the  "Psychopathologie  des 
AUtagslebens." 


202  FREUD'S  THEORY  OF  THE  NEUROSES 

some  illuminating  references  to  reactions  of  the 
patient  to  certain  instructions  or  communications 
of  the  physician  which  reveal  unconscious  proc- 
esses. Among  these  reactions  of  the  patient,  the 
one  called  by  Freud  the  "unconscious  yes"  is 
especially  to  be  noticed ;  under  this  term,  Freud 
understands  associations  which  contain  something 
corresponding  to  the  assertion  of  the  physician 
but  not  directly  confirmatory.  A  further  indi- 
rect confirmation  that  the  veiled  unconscious  ma- 
terial has  become  manifest  to  conscious  percep- 
tion is  an  accidental  laughing  by  the  patient  in 
the  treatment  which  occurs  when  the  content  of 
disclosed  material  in  no  way  justifies  it.  Other 
forms  of  affirmation  are  a  failure  to  understand 
things  which  come  from  the  unconscious ;  in  gen- 
eral, there  is  no  ^'unconscious  no."  From  this 
standpoint,  "no"  which  one  is  accustomed  to  hear 
from  the  patient  after  one  has  first  laid  bare  the 
unconscious  thoughts  to  his  conscious  perception, 
is  to  be  received  only  as  a  continuation  of  the  re- 
pression; its  resoluteness  likewise  lacks  the 
strength  of  the  same.  If  one  considers  this  "no" 
not  as  the  expression  of  an  impartial  judgment, 
of  which  the  patient  is  not  capable,  but  passes 
lightly  over  it  and  continues  the  work,  the  first 
evidence  soon  appears  that  "no"  in  such  a  case 
has  the  significance  of  the  expected  yes.  In  a 
similar  sense  is  also  to  be  considered  the  very  fre- 


PSYCHO-ANALYTIC  METHOD  203 

quent  manner  of  the  patient  in  seeking  to  reject 
some  information  which  has  come  up  out  of  the 
repressed  by  replying  to  a  hint  of  the  physician 
concerning  this  with  "I  knew  you  would  say 
that!"  A  further  rule  which  has  been  derived 
empirically  from  psycho-analytic  technique  is 
that  an  inner  but  still  hidden  connection  is  indi- 
cated by  the  contiguity,  the  temporal  relationship 
of  the  associations,  just  as  a  and  h  in  script  placed 
beside  each  other  mean  that  the  syllable  ah  should 
be  formed.  A  further  experience  teaches  that 
in  cases  where  the  narrator  is  doubtful  in  ex- 
pressing an  opinion,  one  should  entirely  overlook 
this  uncertainty  and  consider  the  opinion  in  the 
affirmative  sense.  Between  the  two  forms  of  a 
wavering  presentation  one  should  consider  the 
first  given  as  the  correct  one,  the  second  as  a  prod- 
uct of  the  repression.  Based  on  this  experience 
is  the  device  of  the  interpreter  of  dreams  of  hav- 
ing a  dream  related  a  second  time  and  beginning 
the  work  of  interpretation  at  the  places  which 
have  been  changed  as  the  least  assured. 

From  this  highly  incomplete  and  unsystema- 
tized information  concerning  the  technique  of  the 
psycho-analytic  method,  one  might  conclude  that 
the  originator  of  the  system  had  caused  himself 
an  excessive  amount  of  trouble  and  done  wrong 
in  giving  up  the  less  complicated  hypnotic 
methods.     But  on  the  one  hand,  the  technique  of 


204     FREUD'S  THEORY  OF  THE  NEUROSES 

psycho-analysis  is  much  easier  to  practice,  once  it 
has  been  learned,  than  a  description  of  it  would 
indicate;  on  the  other  hand,  no  other  way  leads 
to  the  goal,  hence  the  roundabout  way  is  the 
shortest.  Hypnosis  is  to  be  rejected  because  it 
covers  the  resistance  and  thereby  obstructs  the 
physician's  view  of  the  play  of  mental  forces.  It 
does  not  remove  the  resistance,  but  only  evades 
it,  gives  incomplete  information  and  only  tem- 
porary results. 

The  task  which  the  psycho-analytic  method  is 
called  upon  to  solve  may  be  expressed  in  dif- 
ferent formulae  w^hich  are,  however,  essentially 
equivalent.  It  may  be  said,  the  object  of  the 
treatment  is  to  abolish  the  amnesias.  If  all  the 
gaps  in  the  memory  are  filled  out,  all  enigmatical 
effects  of  the  mental  life  explained,  a  continu- 
ance, indeed  a  recurrence  of  the  suffering  is  ren- 
dered impossible.  The  condition  may  be  put 
differently:  to  trace  back  all  repressions;  the 
mental  condition  is  then  the  same  as  that  in  which 
all  amnesias  are  filled.  Far  more  important  is 
another  conception:  to  make  the  unconscious  at- 
tainable to  consciousness,  which  comes  about 
through  the  overcoming  of  the  resistances. 
Thereby  a  piece  of  educational  work  is  accom- 
plished and  for  such  a  reeducation  for  the  over- 
coming of  the  deviations  of  childhood,  one  can 
conceive  a  very  general  application  for  the  psy- 


PSYCHO-ANALYTIC  METHOD  205 

cho-analytic  treatment.  One  must  not  forget, 
however,  that  such  an  ideal  condition  does  not 
exist  among  normal  people  and  that  only  seldom 
does  one  have  the  opportunity  to  conduct  the 
treatment  so  far.  Just  as  health  and  sickness 
are  not  separate  entities  but  are  only  divided  by 
practical  definite  boundaries,  so  one  will  never 
set  up  as  a  goal  for  the  treatment  anything  but 
the  practical  healing  of  the  sick,  the  restoration 
of  their  power  to  work  and  love.  In  an  incom- 
plete treatment  or  incomplete  results  of  the  same, 
one  gains  especially  an  important  improvement 
of  the  general  mental  condition  while  one  or  an- 
other symptom,  but  with  diminished  significance 
for  the  patient,  can  continue  without  branding 
him  as  an  invalid. 

Aside  from  certain  modifications  which  the 
representation  of  a  special  therapy  demands,  the 
therapeutic  method  remains  the  same  for  all  the 
clinical  pictures  of  the  many  varieties  of  hysteria 
as  well  as  for  all  manifestations  of  the  obsessional 
neurosis.  Of  the  unlimited  applicability  of  the 
same,  there  is  no  question.  The  nature  of  the 
psycho-analytic  method  imposes  indications  and 
contraindications  both  in  regard  to  the  persons  to 
be  treated  and  also  to  the  clinical  picture.  Most 
favorable  for  psj^ho-analysis  are  the  chronic  cases 
of  psychoneuroses  w^ith  few  violent  or  dangerous 
symptoms;  thus,  all  kinds  of  obsessional  neu- 


206     FREUD'S  THEORY  OF  THE  NEUROSES 

rosis,  obsessional  thinking  or  obsessional  acts  and 
cases  of  hysteria  in  which  phobias  and  abulias  play 
the  chief  roles;  further  also  all  somatic  expres- 
sions of  hysteria  except  those,  such  as  anorexia, 
where  a  rapid  amelioration  of  the  symptoms  is  the 
chief  task  of  the  physician.  In  acute  cases  of 
hysteria,  one  must  await  the  appearance  of  a 
quiet  state;  in  all  cases  in  which  nervous  exhaus- 
tion is  the  prominent  symptom,  one  should  avoid 
a  method  which  itself  demands  an  effort,  makes 
only  slow  progress  and  for  a  long  time  can  pay 
no  regard  to  a  continuation  of  the  symptoms. 

Concerning  the  persons  on  whom  psycho-anal- 
ysis can  be  undertaken  with  profit,  there  are  sev- 
eral conditions  to  be  observed.  First  of  all,  they 
must  possess  a  normal  mental  condition  from 
which  the  pathological  material  can  be  gained;  in 
times  of  mental  confusion  or  melancholic  depres- 
sion, though  of  hysterical  type,  nothing  can  be 
accomplished.  Further,  a  certain  degree  of  nat- 
ural intelhgence  and  ethical  development  is  neces- 
sary; with  worthless  persons,  the  interest  of  the 
physician  which  strengthens  him  for  delving  into 
the  mental  life  of  the  patient  soon  wanes.  Out-' 
spoken  defects  of  character,  traits  of  actual  con- 
stitutional degeneration  exhibit  themselves  in  the 
treatment  as  sources  of  resistances  which  can 
scarcely  be  overcome.  In  general,  the  constitu- 
tion sets  a  limit  for  the  effectiveness  of  psycho- 


% 

PSYCHO-ANALYTIC  METHOD  207 

therapy.  A  too  mature  age,  in  the  neighborhood 
of  the  fifth  decade,  imposes  unfavorable  condi- 
tions for  psycho-analysis.  The  mass  of  psychic 
material  is  then  no  longer  amenable  to  change, 
the  time  required  for  a  cure  becomes  too  long  and 
the  possibility  of  making  psychic  processes  attain- 
able begins  to  diminish. 

In  spite  of  all  these  limitations,  the  numBer  of 
persons  suited  to  psycho-analysis  is  extraordi- 
narily large  and  the  increase  of  our  therapeutic 
power  by  this  method  is  very  considerable. 
Freud  demands  a  long  period  of  time,  from  a  half 
to  three  years,  for  an  effective  treatment ;  he  ssljs, 
however,  that  so  far  he  has  applied  his  treatment, 
because  of  circumstances  easily  guessed,  to  very 
severe  cases,  persons  with  maladies  of  many  years 
duration  and  complete  incapacity  for  work,  who 
having  tried  all  treatments  came  to  his  new  and 
much  disputed  treatment  as  a  last  resort.  In 
cases  of  less  severity,  the  duration  of  the  treat- 
ment might  be  correspondingly  shortened  and  an 
extraordinary  gain  be  made  for  prevention  in  the 
future.  This  applies  especially  to  the  neuroses 
of  children,  the  frequency  and  importance  of 
which  is  not  yet  sufficiently  appreciated;  accord- 
ing to  the  results  obtained  so  far,  they  are  very 
favorable  cases  for  psycho-analysis.  For  the 
treatment  of  these,  it  is  recommended  that  besides 
the  personal  observation  of  the  child,  his  involun- 


208     FREUD'S  THEORY  OF  THE  NEUROSES 

tary  expressions  be  observed  by  a  trustworthy  and 
suitable  person  (preferably  when  possible,  the 
parents)  who  can  keep  him  under  observation  the 
whole  time.  As  a  means  of  combating  the  in- 
sanities, the  method  is  not  yet  correspondingly 
elaborated  and  modified;  still,  isolated  cases  oL 
investigation  undertaken  by  the^^ZurichL  school 
seem  to  justify  the  expectation  that  the jgsycho- 
analytic  method  may  prove  therapeutjcaJlyieffec- 
tiveup  t'o'alserfaln^oint  in  some  forms  of  in- 
sairity7such~a^  dementia  pr^ox^ahd  paranoia. — ^ 

The  art  of  psycho-analytic  treatment  as  de- 
scribed, which  places  the  greater  share  of  work  on 
the  patient,  might  awaken  the  idea  that  we  are 
dealing  with  a  technique  easily  learned  and  ap- 
plied. If  it  be  granted  that  its  practice  by  a 
skilled  physician  suited  to  it,  with  sufficient  time 
to  give  to  it,  offers  no  difficulties,  still,  the  ac- 
quirement of  the  technique  demands  great  perse- 
verance and  patience  especially  from  beginners. 
First  of  all,  the  patient's  associations,  which  are 
the  foundation  of  the  treatment,  do  not  always 
flow  as  freely,  fully  and  in  the  desired  clearness 
as  is  necessary  for  a  perceptible  progress  of  the 
treatment.  The  very  nature  of  the  neurotic  mal- 
ady and  the  processes  of  repression  at  w^ork  caus- 
ing it  makes  certain  that  the  different  psychic  in- 
hibitions can  be  removed  only  under  a  resistance. 


PSYCHO-ANALYTIC  METHOD  209 

the  size  of  which  corresponds  to  the  forces  which 
had  shared  in  the  repression.  The  patient,  he- 
cause  of  the  malady,  apphes  all  the  means  of  the 
censor,  concealment,  disguise,  symbolism,  to  ren- 
der inaccessible  the  object  of  the  search,  the  re- 
pressed unconscious  sexual  root.  Thus,  the 
treatment  progresses  under  a  constant  struggle 
against  the  ever-appearing  resistance.  The  dis- 
closure of  the  unconscious  mental  life  is  of  neces- 
sity accompanied  by  discomfort  and  hence  always 
retarded  by  the  patient.  One  can  estimate  the: 
difficulties  of  the  process  by  considering  that  the 
treatment  only  approaches  its  end  when  all  the 
strata  of  the  mental  life  have  been  penetrated  and  / 
all  gaps  in  memory  (amnesias)  of  the  patient, 
even  to  the  earliest  childhood,  have  been  filled  out. 
The  great  abundance  of  experiences  which  after 
decades  of  sickness  finally  become  inexhaustible 
as  well  as  the  necessary  resistances  under  which 
the  actual  rendering  conscious  of  the  unconscious 
proceeds  are  the  circumstances  which  sorely  try 
the  patience  of  patient  and  physician  and  can  pro- 
tract the  treatment  many  months  and  even  years. 
This  demand  on  the  patience  of  the  patient  dimin- 
ishes in  contrast  to  the  patience  which  the  con- 
tinuance of  the  pathological  phenomena  requires 
of  him. 

In  the  end,  it  is  the  content  of  infantile  repres- 
sion which  contains  the  pathogenic  material  which 


210  FREUD'S  THEORY  OF  THE  NEUROSES 

I  cannot  be  at  all  clearly  obtained  from  the  patient 
]f  but  must  be  in  part  guessed  by  the  physician  on 
;  the  ground  of  his  previous  experience  and  ar- 
/!  ranged  so  that  the  patient's  consciousness  will  per- 
ceive his  unconscious  wish-impulses.  We  attain 
this  by  bringing  before  his  consciousness  in  our 
own  language  the  unconscious  complexes  which 
he  has  given  hints  of  possessing  and  which  the  art 
of  interpretation  has  assisted  in  revealing.  The 
similarity  between  what  he  has  heard  and  what  he 
seeks  will  penetrate  consciousness  in  spite  of  all 
resistance  and  put  him  in  a  position  to  find  the 
unconscious.  The  physician  is  a  little  ahead  in 
comprehension,  the  patient  follows  in  his  own 
way  until  both  reach  the  goal  aimed  at.  Begin- 
ners in  psycho-analysis  seek  to  change  these  two 
points  and  to  consider  the  time,  at  which  they 
recognized  an  unconscious  complex  of  the  patient, 
the  same  as  that  at  which  the  patient  perceived 
it.  They  expect  too  much  if  they  would  heal  the 
patient  by  communicating  this  knowledge,  for  he 
can  only  use  the  communication  as  an  aid  in  find- 
ing the  unconscious  complex  in  his  unconscious 
where  it  is  fixed.  With  this  part  of  the  analysis, 
that  purely  expectant  attitude  of  the  physician 
which  was  formerly  laid  down  as  a  condition  of  the 
treatment  finds  a  limitation.  It  is  important 
here  that  the  skillful  physician  should  not  leave 
his  patient  unprepared  and  as  a  rule  he  has  to  ask 


PSYCHO-ANALYTIC  METHOD  211 

from  him  not  enlightenment  but  merely  confirma- 
tion of  his  suspicions.  The  psycho-analysis  of  a 
patient  is  no  aimless  scientific  investigation  but  a 
therapeutic  procedure ;  it  wishes  to  prove  nothing, 
merely  to  change  something.  Every  time  in  the 
analysis,  the  physician  gives  the  patient  the  con- 
scious ideas  expected,  by  the  help  of  which  he  will 
be  in  position  to  recognize  and  comprehend  the 
unconscious.  What  the  physician  communicates 
to  the  patient  comes  from  other  analytic  expe- 
riences and  it  is  really  proof  enough  if  by  the  aid 
of  this  medical  intervention  the  connection  and 
solution  of  the  pathogenic  material  is  attained. 
The  best  way  to  introduce  these  expected  ideas  is 
by  giving  the  patient  on  suitable  occasion  a  view 
of  the  meaning  and  procedure  of  psycho-analytic 
therapy  as  well  as  its  psychological  presupposi- 
tions, for  example,  by  explaining  to  him  the  im- 
portance of  the  psychological  distinction  between 
conscious  and  unconscious,  concerning  infant- 
ilism, etc.,  and  wherever  possible  allowing  him  to 
find  and  comprehend  it  from  his  own  material.  ^^ 
Nevertheless,  it  should  never  be  the  aim  of  such 
discussions  to  convince.  They  should  introduce 
the  repressed  complexes  to  consciousness,  insti- 
gate the  strife  with  them  on  the  floor  of  con- 
scious mental  activity  and  render  easier  the  ap- 

10  The  reading  of  published  articles  by  the  patient  is  not  ad- 
vantageous to  the  treatment. 


212     FREUD'S  THEORY  OF  THE  NEUROSES 

pearance  of  new  material  from  the  unconscious. 
Conviction  comes  only  after  the  material  won 
from  the  unconscious  has  been  elaborated  by  the 
patient,  and  so  long  as  he  is  wavering  one  must 
consider  the  material  as  not  exhausted. 

Without  having  won  an  intellectual  conviction, 
however,  the  patients  indulge  in  that  pecuUar 
cessation  of  authoritative  belief  and  of  the  need 
of  instruction  from  the  physician  and  on  the  con- 
trary show  an  emotional  interest  in  these  things 
and  through  this  to  gradually  participate  intel- 
lectually in  the  theory.  We  come  here  upon  a 
highly  important  agency  of  the  psycho-analytic 
treatment,  namely,  the  condition  of  "transfer- 
ence" ("Ubertragung")  ^^  as  Freud  has  called  that 
peculiar  psychic  dependence  and  respectful  sym- 
pathy which  the  neurotic  brings  to  the  physician 
whom  he  trusts,  and  without  the  appearance  of 
which,  as  occasionally  happens  because  of  uncon- 
genial personalities,  the  treatment  terminates 
spontaneously  soon  after  its  beginning.^^  This 
so-called  transference  is  at  bottom  nothing  else 
than  what  occurs  in  every  psychic  influencing,  in- 

11 A  comprehensive  presentation  of  the  "transference"  is  de- 
ferred until  the  title  "general  therapy"  is  reached.  As  pre- 
liminary, compare  Freud  (Lit.  No.  21)  as  well  as  Ferenczi, 
"Introjektion  und  tJbertragung"  (Jahrb.,  T,  page  422). 

12  Striking  results  right  at  the  beginning  of  the  psycho-analytic 
treatment  rest  merely  on  transference  and  are  mostly  only  tem- 
porary apparent  results. 


PSYCHO-ANALYTIC  METHOD  213 

deed  one  can  say  that  in  general  no  medical  treat- 
ment is  possible  without  a  certain  degree  of  con- 
fiding sympathy  from  the  sufferer.  According 
to  Freud's  experience,  it  is  especially  certain  that, 
for  example,  the  sanitarium  treatment  also  de- 
pends only  on  such  a  subordination  of  sympa- 
thetic emotions  to  the  authority  of  the  esteemed 
physician.  Now,  neurotics  are  really  much 
richer  in  free  movable  craving  for  love  (Hbido), 
the  quantity  of  which  is  constantly  increased  by 
the  analytic  breaking  down  of  inhibitions,  so  that 
ft  is  no  wonder  that  this  sympathetic  relation  to 
the  physician  becomes  more  intense  and  emotion- 
ally toned  than  in  patients  with  organic  disease. 
What  is  more  obvious  than  that  this  free  floating 
libido  (in  widest  extent  of  eroticism)  freed  from 
the  repression  in  the  way  of  sublimated  homo-  or 
heterosexuality  should  be  transferred  to  the  at- 
tending physician  whose  intimate  and  prolonged 
dealing  with  the  mental  life  of  patients  is  the  most 
favorable  soil  for  such  seeds.  Thus,  transfer- 
ence is  not  a  specific  result  of  psycho-analytic 
therapy  but  it  appears  here  most  clearly  because 
of  the  conditions  under  which  the  treatment  is 
carried  out.  Sentimental  critics  need  not,  .how- 
ever, get  angry  at  the  thought  that  the  physician 
could  use  or  abuse  this  relation  in  any  way.  On 
the  contrary,  the  real  effectiveness  of  this  most 
important  aid  in  the  psycho-analytic  treatment 


214  FREUD'S  THEORY  OF  THE  NEUROSES 

consists  just  in  the  fact  that  one  has  to  continually 
release  the  patient  from  his  transference  by  ex- 
plaining to  him  that  his  whole  intense  interest  in 
the  person  of  the  physician  is  only  a  transference 
of  previous  emotional  impulses  originally  directed 
toward  other  persons.  The  productivity  of  the 
neurosis  is  really  not  interrupted  during  the  psy- 
cho-analytic treatment,  although  the  new  forma- 
tion of  symptoms  ceases,  but  busies  itself  in  the 
creation  of  a  special  kind  of  thought  formations, 
mostly  unconscious,  to  which  the  name  transfer- 
ence is  given  for  the  reason  that  they  are  new  edi- 
tions, later  expressions  of  impulses  or  phantasies 
which  have  been  awakened  during  the  progress 
of  the  analysis  and  should  be  made  conscious. 
These  transference-phantasies  show  themselves 
by  a  characteristic  replacement  of  an  earlier  per- 
son by  the  person  of  the  physician.  To  put  it  dif- 
ferently: A  whole  series  of  earlier  psychic 
events  becomes  active  again,  not  as  something 
Vvhich  has  happened,  but  as  an  actual  relation  to 
the  physician.  To  use  Ferenczi's  apt  comparison 
from  chemistry,  the  physician  plays  the  role  of  a 
catalytic  ferment,  which  in  the  process  of  setting 
free  affects,  draws  them  to  itself.  There  are 
transferences  which  in  their  contents  are  to  be 
distinguished  from  their  prototype  in  absolutely 
nothing.  Thus,  they  are  special  reprints,  un- 
changed new  editions.     Others  are  artfully  ere- 


PSYCHO-ANALYTIC  METHOD  215 

ated  and  have  undergone  a  toning  down  of  their 
content,  a  sublimation,  and  thus  resemble  new 
works.  The  transference  is  a  necessary  part  of 
every  psycho-analytic  treatment  and  one  can 
easily  convince  himself  in  practice  that  it  is  in  no 
way  to  be  avoided  and  that  this  last  phenomenon 
of  the  malady  has  to  be  combated  like  all  the 
earlier  ones.  This  part  of  the  work  is  by  far  the 
hardest  because  one  must  guess  the  transference, 
independently,  without  any  help  from  the  patient, 
in  insignificant  stopping  points  and  without  mak- 
ing himself  guilty  of  arbitrariness.  To  avoid  it, 
however,  is  impossible,  since  it  is  applied  for  the 
origination  of  all  the  obstructions  which  render 
the  material  inaccessible. 

One  will  be  inclined  to  consider  it  a  great  dis- 
advantage of  a  method  otherwise  inconvenient 
that  it  still  increases  the  work  of  the  physician 
through  the  creation  of  a  new  kind  of  pathological 
psychic  product,  indeed  perhaps  may  work  in- 
jury to  the  patient  by  the  analytic  treatment 
through  the  existence  of  the  transference.  Both 
would  be  erroneous.  The  work  of  the  physician 
is  not  increased  by  the  transference ;  it  may  be  in- 
different to  him  whether  the  resurrected  impulse 
of  the  patient  has  to  be  overcome  while  it  is  at- 
tached to  himself  or  to  another  person.  Further, 
the  transference  in  the  treatment  imposes  no  new 
task  upon  the  patient  which  he  would  not  other- 


21«  FREUD'S  THEORY  OF  THE  NEUROSES 

wise  have  performed.  If  recoveries  from  the 
neuroses  also  come  about  through  other  influ- 
ences, still,  it  is  possible  only  because  of  such  a 
latent  working  transference.  The  difference  is 
only  that  the  patient  ordinarily  merely  produces 
affectionate  and  friendly  transference  in  his  re- 
covery. In  the  psycho-analysis,  on  the  contrary, 
all  impulses  corresponding  to  a  change  in  motiva- 
tion, even  hostile  ones  (negative  transference), 
are  awakened,  transferred  to  the  physician  and  by 
being  made  conscious  aid  the  treatment ;  thus  the 
transference  is  always  destroyed  for  good.  The 
transference  which  is  destined  to  become  the 
greatest  hindrance  to  psycho-analysis  is  the 
mightiest  means  of  help  when  one  succeeds  in  de- 
tecting it  immediately  and  translating  it  to  the 
patient.  One  should  not  conclude  that  the  trans- 
ference is  a  sort  of  lasting  attachment  of  the  pa- 
tient to  the  physician,  as,  for  example,  has  been 
the  reproach  of  hypnotic  therapy.  On  the  con- 
trary, it  has  already  been  asserted  that  the  patient 
must  be  constantly  informed  of  it  and  that  the 
physician  should  meet  the  patient  with  a  certain 
cool  aloofness  and  must  really  endeavor  ^^  at  the 
close  of  the  analysis  to  leave  him  as  much  a 
stranger  to  the  patient  as  he  was  before  the  treat- 
ment began;  in  this  way,  not  only  the  genuine 

18  A  similar  transference  on  the  part  of  the  physician  (reversed 
transference)  is  to  be  avoided  by  self -analysis. 


PSYCHO-ANALYTIC  METHOD  217 

cure  of  the  patient  but  also  his  own  independence 
is  attained.  The  one  or  another  symptom  which 
still  persists  often  disappears  entirely  and  for 
good  only  after  the  complete  dissolution  of  the 
transference-relation. 

Against  this  method  of  Freud's  loud  dissenting 
voices  have  repeatedly  been  raised,  characteristi- 
cally though  only  by  those  who  have  never  used 
the  method  at  all  or  only  with  unsatisfactory  re- 
sults. For  every  one  who  has  gained  by  con- 
tinued contact  with  neurotics  an  intimate  insight 
into  the  hysterical  mind  must  have  been  thereby 
convinced  of  the  effectiveness  of  the  Freudian 
therapy.  No  one  can  escape  the  convincing  evi- 
dence of  the  erotic  complexes  always  active  in  the 
foreground  nor  the  accompanying  powerful  re- 
sistances against  these  becoming  conscious.  The 
justice  of  these  empiric  impressions  is  suited  to 
banish  the  last  doubt  of  the  existence  of  the  un- 
conscious and  its  specific  content. 

The  objections  of  the  critics  arise  not  so  much 
from  intimate  knowledge  as  from  a  priori  dislike 
of  the  subject  of  sexuality  which  must  inevitably 
be  dealt  with  in  the  etiology  of  these  pathological 
conditions.  These  same  opponents  are  also  quite 
unjustly  indignant  over  the  therapy  in  respect 
to  the  fear  that  it  may  accomplish  the  seduction 
of  the  patient  and  by  dealing  with  sexual  themes 
and  a  subjectivmus  which  can  only  injure  them. 


I 


218  FREUD'S  THEORY  OF  THE  NEUROSES 

This  kind  of  pretended  suggestion  is,  however, 
nowhere  so  impossible  as  in  psycho-analysis  itself, 
where  the  free-flowing  associations  of  the  patient 
show  the  way  for  the  progress  of  the  treatment. 
On  the  contrary,  the  psycho-analyst  knows  that 
the  analytic  work  stops  immediately  the  moment 
the  physician  seeks  to  suggest  a  wrong  or  forced 
solution.  The  skillful  psycho-analyst  will  in  gen- 
eral limit  himself  as  far  as  possible  to  the  passive 
role  of  listener.  Then  the  neurotic  patient  him- 
self often  brings  forward  his  sexual  and  erotic 
phantasies  and  one  needs  onty  once  to  see  the  feel- 
ing of  relief  on  the  patient's  part  who  has  for  the 
first  time  accused  himself  before  a  judge  who  un- 
derstands, in  order  to  be  certain  that  there  can  be 
no  question  of  suggestion.  Freud  has  never  in- 
sisted, as  some  superficial  reviewers  believe,  upon 
forcing  a  free  indulgence  of  the  sexual  appetite. 
He  asserts,  rather,  that  the  recommendation  of 
sexual  activity  to  psychoneurotics  is  mostly  to  be 
considered  bad  counsel,  because  in  the  mechanism 
of  the  neurosis  not  merely  the  sexual  need  and 
deprivation  come  into  play.  The  other  just  as 
important  and  indispensable  factor  which  is  all 
too  readily  forgotten  is  the  sexual  disinclination 
of  neurotics,  their  incapacity  for  love,  that  psychic 
trait  on  which  the  repression  rests ;  it  is  from  the 
conflict  between  these  two  tendencies  that  the  neu- 
rotic   malady    develops.    The    psycho-analytic 


PSYCHO-ANALYTIC  METHOD  219 

treatment  aims  not  at  all  at  freeing  the  instincts  J 
from  the  repression,  so  that  they  may  be  indulged  / ' 
unhampered,  but  has  in  view  the  bringing  of  the 
patients  to  the  point  where  they  can  control  the 
same,  partly  by  conscious  mental  forces,  partly 
by  conducting  it  to  a  higher  and  therefore  unob- 
jectionable goal  (sublimation).  The  fear  occa- 
sionally expressed  that  the  unchaining  of  the  sup- 
pressed evil  instincts  may  bring  injury  becomes 
groundless  through  the  experience  that  the 
psychic  and  somatic  power  of  such  instinctive  im- 
pulses is  only  weakened  by  bringing  them  into 
consciousness. 

If  it  is  further  objected  that  there  is  a  danger 
to  the  individual  as  well  as  to  societj^  in  discussing 
the  sexual  theme  in  its  widest  extent  and  in  all 
detail  during  the  psycho-analytic  treatment,  that 
the  physician  has  no  right  to  penetrate  into  the 
sexual  secrets  of  his  patients,  that  he  may  wound 
their  modesty — especially  of  the  women — 
through  such  gross  examination,  that  his  awk- 
ward hand  may  disturb  family  peace,  that  he  may 
destroy  the  innocence  of  young  persons  and  en- 
croach upon  parental  authority,  acquire  disturb- 
ing knowledge  of  private  affairs  of  adults  and  dis- 
turb his  own  relation  to  the  patients,  it  may  be 
answered:  This  is  the  language  of  an  unworthy 
prudery  of  the  physician  which  imperfectlj^ 
covers  his  incompetency  with  bad  arguments. 


220     FREUD'S  THEORY  OF  THE  NEUROSES 

If  agencies  from  the  sexual  life  are  recognized 
as  really  causing  disease,  then  the  development 
and  discussion  of  these  agencies  hereby  falls  with- 
out further  thought  into  the  duty  of  the  physi- 
cian. The  wounding  of  modesty  of  which  he 
may  be  guilty  is  no  different  and  no  worse  than 
he  would  inflict  if  in  order  to  heal  a  local  affec- 
tion of  the  female  genitals  he  made  a  digital  or 
visual  examination  which  the  school  imposes 
upon  him  as  a  duty.  ^ 

Occasionally  one  also  hears  the  objection  to 
the  psycho-analytic  treatment,  which  must  be 
classed  as  almost  malevolent,  that  the  psycho- 
analytic treatment  oftener  than  any  other  in- 
jures the  patient,  indeed  may  occasion  suicide. 
So  far  as  it  is  not  direct  personal  hostility  which 
dictates  this  reproach,  it  is  the  resistance  against 
something  new  which  forgets  that  hydrotherapy 
and  other  therapeutic  methods  sometimes  treat  as 
a  neurosis,  conditions  which  are  really  beginning 
psychoses.  Also,  one  will  judge  otherwise  if 
one  has  got  in  the  habit  of  charging  to  the  treat- 
ment everything  which  happens  during  the  treat- 
ment of  a  case  of  disease.  Occasionally,  appar- 
ent retrogressions  in  the  neurotic  pathological 
condition  will  appear  through  acute  conditions 
in  no  way  chargeable  to  the  treatment  but  which 
are  in  most  cases  necessary  and  healthful  erup- 
tions of  the  unconscious,  strong  reaction  phe- 


PSYCHO-ANALYTIC  METHOD  221 

nomena,  under  which  the  deviation  from  the 
normal  is  corrected,  the  mental  obsession  is 
broken.  In  general,  the  state  of  health  during 
the  treatment  is  no  standard  of  measure  for  the 
final  results. 

The  resistance  against  this  novel  and  not  easily 
acquired  method  of  treatment  manifests  itself 
also  in  a  certain  mischievous  joy  which  is  shown 
when  occasionally  results  are  not  immediately 
forthcoming  or  are  absent  altogether.  Now  it 
happens  often  as  related  that  the  result  does  not 
follow  immediately  on  the  termination  of  the 
treatment  but  that  the  condition  of  the  patient 
only  first  approaches  health  some  time  after  the 
end  of  the  analysis  and  indeed  from  the  time  at 
which  the  relations  to  the  physician  are  com- 
pletely and  smoothly  dissolved.  The  delay  in 
the  cure  or  improvement  seems  in  general  to  be 
essentially  conditioned  on  the  earlier  described 
transference-relation.  Moreover,  the  results  in 
the  treatment  of  the  neuroses  are  often  shattered 
by  affairs  in  the  external  life  of  the  patients,  the 
healthful  changing  of  which  lies  beyond  the 
power  of  the  physician.  Against  the  recovery, 
stand  many  kinds  of  unconscious  motives,  since 
the  patients  fled  to  the  neurosis  and  thus  many  a 
symptom,  in  spite  of  an  analysis  which  has  pro- 
gressed far,  is  not  to  be  got  rid  of  because  of  this 
obstinacy  of  such  a  "secondary  function"  in  men- 


222     FREUD'S  THEORY  OF  THE  NEUROSES 

tal  life  which  nourishes  such  a  mental  disturbance. 
He  who  wishes  to  make  the  patient  well  stumbles 
to  his  astonishment  upon  a  great  resistance  which 
teaches  him  that  the  patient  is  not  sincere  in 
wanting  to  get  rid  of  his  suffering.  In  the  battle 
of  these  disease  motives,  as  Freud  calls  them,  lies 
quite  generally  the  weakness  of  any  therapy  and 
also  of  the  psycho-analytic.  Thus,  for  example, 
when  a  neglected  wife,  or  one  who  feels  herself 
neglected,  knows  how  to  gain  through  sickness 
sympathy,  attention  and  love  from  her  husband 
which  she  lacked,  by  the  relinquishment  of  which 
the  previous  dull  married  life  would  begin  again. 
In  general,  it  is  a  prerequisite  of  every  possi- 
bility of  cure  that  the  patient  suffers  from  his 
symptoms  or  better  said  suffers  more  than  what 
he  gains  from  his  sickness.  An  homosexualist,  a 
f etichist,  a  pervert  will  as  a  rule  absolutely  refuse 
to  give  up  his  pathological  tendencies.  Whether 
this  case  occurs  from  external  or  internal  causes, 
however,  taking  into  consideration  the  least  in- 
fluenced cases  as  well  as  the  most  favorably  in- 
fluenced, one  must  still  consider  the  psycho- 
analytic therapy  the  method  of  choice  in  such  ab- 
normal conditions.  It  should  be  expressly  men- 
tioned that  a  psycho-analytic  treatment,  though 
incomplete,  may  show  relatively  good  results  by 
making  the  patient  cheerful  and  capable  of  work 
and  play.    And  even  if  the  patient  is  not  com- 


PSYCHO-ANALYTIC  METHOD  223 

pletely  restored  to  health,  still  he  has  usually 
learned  to  partially  diminish  his  symptoms  by 
self -interpretation  and  to  control  his  unconscious. 
From  all  this,  one  sees  that  the  method  of  psy- 
cho-analysis makes  high  demands  both  on  the 
patient  and  the  physician;  from  the  former,  it 
demands  the  offering  of  complete  sincerity,  a  con- 
siderable amount  of  time  and  hence  a  good  deal 
of  expense;  from  the  physician,  it  also  demands 
much  time  and  therefore  makes  desirable,  as  well 
as  because  of  the  tediously  learned  and  difficult 
technique,  a  specialization  in  this  field.  It  is 
therefore  intelligible  that  one  might  prefer 
methods  which  promised  cure  more  conveniently 
and  in  shorter  time.  At  first  there  came  into  the 
hands  of  the  psycho-analyst  mostly  patients  who 
had  already  sought  all  other  methods  in  vain  and 
had  spent  years  in  sanitaria.  These  patients, 
however,  are  in  about  the  condition  of  sufferers 
from  tuberculosis  who  have  cavities  in  their 
lungs ;  treated  as  light  catarrh  of  the  apices,  they 
would  have  yielded  dazzling  results.  It  should 
not  be  said  that  psycho-analysis  cannot  heal 
severe  cases  of  neurosis — the  technique  has  been 
founded  and  proven  on  just  such  cases — never- 
theless, these  cases  must  come  at  the  right  time 
into  the  hands  of  suitable  psycho-analysts. 
There  is  still  lacking  and  will  be  for  a  long  time 
a  sufficiently  widespread  recognition  of  the  na- 


224     FREUD'S  THEORY  OF  THE  NEUROSES 

ture  and  significance  of  psychoneurotic  maladies, 
both  among  medical  circles  and  the  laity,  and 
herein  lie  the  essential  difficulties  which  now  op- 
pose the  psycho-analytic  method  and  not,  as  is 
still  always  supposed,  in  the  thing  itself.  The 
psychoneuroses  as  a  class  are  not  at  all  mild  dis- 
eases, as  in  greatest  part  the  physicians  and  more 
yet  the  laity  suppose;  the  latter  is  firmly  con- 
vinced of  the  superfluousness  of  all  these  disease 
phenomena  and  therefore  neither  brings  a  pa- 
tience for  the  course  of  the  disease  nor  a  special 
readiness  to  sacrifice  to  the  therapy.  The  sin- 
cerity of  the  physicians  and  the  accommodation 
of  the  laity  will  be  established  for  the  psycho- 
neuroses  when  it  shall  be  known  that  a  severe 
neurosis,  in  its  importance  for  the  afflicted  indi- 
vidual, is  not  one  whit  behind  any  of  the  feared 
general  diseases  and  that  the  restoration  from 
years  of  incapacitating  sufferings,  corresponding 
in  degree  to  their  energies,  is  not  to  be  expected 
in  a  few  weeks  nor  from  a  treatment  which  causes 
no  inconvenience.  The  psycho-analytic  therapy 
has  the  triumph  of  having  made  permanently 
capable  of  existence  a  gratifying  number  of  all 
the  severest  cases,  and  against  these  results  all 
objection  is  insignificant.  Hence  ijt  is  obvious 
lat  the  analytic  treatment  in  the  mild  periodi- 
cally Spearing  maladies  or  m  thelnitial  stages  of 
severer  cases  can  obtain  brilliant  and  often  sur- 


PSYCHO-ANALYTIC  METHOD  225 

grisingly  rapid  and  lastjngjresults;  it  is  only  a 
question  of  time  and  of  the  increasing  knowledge 
of  these  maladies  when  psycho-analysis  will  be 
able  to  prove  its  great  cultural  and  social  impor- 
tance as  a  real  prophylactic  method  (education, 
enlightenment) . 


CHAPTER  IX 

GENERAL   PROPHYLAXIS   OF  THE  NEUROSES 

Cultural  Sexual-morality.  Sexual  Education.  Sex- 
ual Enlightenment. 

Physicians  are  accustomed  to  being  unsatis- 
fied with  the  mere  curing  of  a  disease  and  to  seek 
the  ideal  condition  in  its  prevention.  This  im- 
portant point  must  be  discussed:  How  do  the 
new  facts  concerning  the  etiology  of  the  neuroses 
affect  their  prophylaxis?  Freud  has  expressed 
himself  in  detail  on  some  of  these  points  in  his 
article  ''Die  kulturelle  Sexualmoral  und  die 
moderne  Nervositat"  ^  (Cultural  Sexual-mor- 
ality and  Modern  Nervousness)  and  come  there 
to  the  consoling  opinion  that  the  frequency  of 
nervous  maladies  in  our  time  is  not  due  to  the 
progress  of  civilization  and  the  acquisitions  of 
technical  science  nor  to  the  complex  and  rushing 
manner  of  life  of  civilized  men,  as  has  been  gen- 
erally held.  It  is  not  so  much  that  this  wide- 
spread view  is  erroneous  as  that  it  is  inadequate 
to  explain  the  peculiarities  of  the  phenomena  of 

iLit.  No.  30. 

226 


GENERAL  PROPHYLAXIS  227 

the  nervous  disturbances  and  leaves  out  of  ac- 
count the  most  important  of  etiological  factors. 
If  one  looks  away  from  the  more  indefinite  kinds 
of  "being  nervous"  and  limits  his  attention  to  the 
genuine  forms  of  nervous  maladies,  he  finds  the 
injurious  influence  of  civilization  really  nar- 
rowed down  to  the  injurious  suppression  of  the 
sexual  life  of  civilized  people  (or  classes) 
through  the  prevailing  cultural  sexual  morality. 
The  Freudian  investigations  have  shown  that 
culture  has  been  quite  generally  built  upon 
the  suppression  of  the  instincts.  Experience 
teaches,  however,  that  for  most  people  there  is  a 
limit  beyond  which  their  constitution  cannot  fol- 
low cultural  demands.  It  is  one  of  the  most 
manifest  social  injustices  that  the  cultural  stand- 
ard should  demand  of  all  persons  the  same  con- 
duct of  the  sexual  life  which  is  possible  for  some 
on  account  of  their  organization  without  trouble, 
while  on  others  it  imposes  the  greatest  mental 
hardship.  Really,  in  this  way,  the  relatively 
large  number  of  perverts  is  occasioned.  Many 
idealistic  reformers  would  even  sharpen  still  more 
the  sexual  morality  by  demanding  from  indi- 
viduals of  both  sexes  abstinence  before  marriage 
and  lifelong  abstinence  for  all  who  cannot  enter 
into  a  legitimate  marriage.  To  such  an  one,  we 
may  answer  in  opposition  that  the  task  of  con- 
quering^ such  a  mighty  impulse  as  the  normal 


228     FREUD'S  THEORY  OF  THE  NEUROSES 

sexual  instinct  can  take  all  the  strength  of  a 
man.  The  conquering  through  sublimation,  the 
transference  of  the  forces  of  the  sexual  instinct 
from  sexual  ends  to  higher  cultural  aims,  suc- 
ceeds in  only  a  minority;  most  of  the  others  either 
become  neurotic  or  come  to  other  injury.  Ex- 
perience shows  that  the  majority  of  persons  com- 
posing our  society  are  not  constitutionally 
adapted  to  endure  abstinence.  Those  who  would 
become  ill  under  a  more  liberal  sexual  limitation 
become  sick  just  so  much  earlier  and  so  much 
more  intensely  because  of  the  demands  of  our 
present-day  cultural  sexual  morality,  for  against 
the  menace  of  a  normal  sexual  impulse  through 
bad  heredity  and  disorders  of  development,  we 
know  no  better  security  than  sexual  gratification 
itself.  The  more  any  one  is  predisposed  to  a 
neurosis,  the  wors^he  bears  abstinence.  The 
dammed-up  libido  is  really  placed  in  a  condition 
to  hunt  out  any  weak  place  which  is  seldom  lack- 
ing in  the  sexual  life,  there  to  break  through  into 
neurotic  substitute  gratification  in  the  form  of 
symptoms.  He  who  knows  how  to  penetrate 
into  the  conditions  of  nervous  maladies  soon  be- 
comes convinced  that  the  increase  of  nervous  dis- 
eases in  our  society  arises  from  the  increase  of 
sexual  limitations.  In  the  vast  majority  of 
cases,  the  struggle  against  sensuality  saps  the 
available  energy  of  character,  and  this  just  at  a 


GENERAL  PROPHYLAXIS  229 

time  when  the  young  man  needs  all  of  his  powers 
to  win  his  lot  and  place  in  society.  On  the  other 
hand  there  is  the  onanism,  often  continued  into 
the  adult  years,  and  when  treating  the  question 
of  abstinence,  one  distinguishes  much  too  little 
two  forms  of  the  latter:  the  refraining  from  all 
sextial  activity  and  the  refraining  from  sexual  in- 
tercourse with  the  opposite  sex.  Many  persons 
who  boast  of  abstinence  from  the  other  sex  have 
accomplished  this  only  by  the  aid  of  masturba- 
tion. Further,  this  corresponds  in  no  way  to  the 
ideal  demands  of  cultural  sexual  morality  and 
therefore  drives  the  young  man  into  the  same  con- 
flict with  the  educational  ideal  which  he  would 
escape  through  abstinence.  It  further  ruins  the 
character  in  more  ways  than  one,  chiefly  however, 
because  the  sexual  activity  of  a  man  is  a  model 
for  his  whole  way  of  reacting  in  the  world  (psy- 
cho-sexual parallelism).  To  one  who  has  ener- 
getically won  his  sexual  object,  we  give  credit 
for  similar  reckless  energy  in  the  pursuit  of  other 
goals.  On  the  other  hand,  he  who  for  various 
reasons  renounces  the  gratification  of  his  strong 
sexual  instinct  will  also  be  rather  conciliatory 
and  resigned  than  energetic  in  other  affairs  of 
life.  Even  as  complete  an  abstinence  as  possible 
during  adolescence  is  not  a  young  man's  best 
preparation  for  marriage.  The  suppression  of 
everything  sexual,  this  applies  especially  to  the 


/ 

230     FREUD'S  THEORY  OF  THE  NEUROSES 

strict  educational  rules  for  girls,  as  Freud  has 
expressed  it,  is  frequently  so  well  accomplished 
and  carried  so  far  that  the  sexual  instinct,  after 
being  released,  seems  to  have  suffered  lasting  in- 
jury. 

Further,  the  sexual  intercourse  in  legitimate 
wedlock  offers  no  full  indemnity  for  the  limita- 
tions before  marriage,  chiefly  because  that  very 
frequently  from  cultural  and  material  reasons, 
the  marriage  must  be  satisfied  with  a  limited 
number  of  conceptions,  hence  after  a  few  years, 
the  marital  intercourse  is  limited  by  all  those 
measures  directed  at  the  prevention  of  preg- 
nancy, the  sexual  satisfaction  is  spoiled,  the  finer 
sensibilities  of  both  parties  disturbed  or  where  an 
intolerance  against  these  measures  exists,  the 
health  suffers.  It  is  especially  the  woman  who, 
under  such  marriage  conditions,  may  become 
most  severely  ill  and  endure  for  life  the  sadden- 
ing neurosis.  Marriage  has  thus,  under  present 
cultural  conditions,  long  ceased  to  be  a  panacea 
for  the  nervous  diseases  of  women;  and  if  we 
physicians  still  always  recommend  it  in  such 
cases,  we  know  that  on  the  contrary,  a  girl  must 
be  really  healthy  to  stand  marriage  and  strongly 
advise  our  men  patients  against  marrying  a  girl 
who  has  been  "nervous"  before  marriage.  For  it 
is  also  a  grievous  discovery  for  the  man  to  get  a 
constantly  anesthetic  woman  in  marriage,  a  very 


GENERAL  PROPHYLAXIS  231 

frequent  result  of  the  present  generally  ap- 
proved strict  and  over-moral  education  of  girls. 
The  undersensitive  wife  and  the  husband,  because 
of  chastity  and  masturbation  of  little  potency 
and  especially  frequently  suffering  from  ejacu- 
latio  praecox,  make  a  picture  of  a  modern  ''nerv- 
ous'^ marriage  where  the  incomplete  sexual  grati- 
fication brings  on  that  nervousness  and  irrita- 
bility which  destroys  the  family  life.  The 
neurotic  wife,  ungratified  by  her  husband,  is  as  a 
mother  overaffectionate  and  overanxious  toward 
the  child  to  whom  she  transfers  her  craving  for 
love,  thereby  awakening  in  him  sexual  precocity. 
The  bad  agreement  between  the  parents  excites 
the  emotional  life  of  the  child  and  causes  it  in 
its  tenderest  years  to  feel  intensely  love,  hate 
and  jealousy.  The  strict  education  which  toler- 
ates no  kind  of  expression  of  the  early  awakened 
sexual  life  assists  the  suppressing  power  and  the 
conflict  at  this  age  contains  everything  necessary 
for  the  causation  of  a  lifelong  nervous  invalidism. 
Individual  prophylaxis  must  be  instituted  in 
earliest  childhood  as  the  whole  etiology  of  the 
neuroses  teaches;  according  to  Freud,  this  is  a 
self-evident  fact.  The  child  cannot  be  too  care- 
fully guarded  from  every  evil  influence  from 
other  children  as  well  as  from  adults,  especially 
nurses,  who  are  often  guilty  of  abuse  and  seduc- 
tion of  little  children.     A  constant  oversight  of 


232     FREUD'S  THEORY  OF  THE  NEUROSES 

the  child  and  an  environment  in  no  way  pre- 
carious must  be  most  emphatically  recommended. 
That  the  parents  themselves  in  their  ignorance, 
by  excessive  affection/  boisterous  caresses,  all  too 
frequent"  taking  the  child  into  bed  with  them- 
selves, prematurely  awaken  his  instincts  and 
thereby  bring  injury  upon  him  may  be  again  as- 
serted. That  excessive  masturbation  must  be 
combated  at  the  right  time  has  already  been  em- 
phasized.^ This  should,  however,  not  convey 
the  impression  that  the  avoidance  of  sexual  expe- 
riences which  finally  bring  enlightenment  can  by 
itself  prevent  the  formation  of  neuroses.  It 
must  much  rather  be  expressly  emphasized  that  it 
is  of  decisive  importance  for  the  prophylaxis  that 
no  too  rigorous  demands  for  repression  be  im- 
posed on  the  children,  especially  on  those  with 
bad  heredity.  For  the  relaxation  of  the  repres- 
sion at  the  right  time  corresponding  to  the  de- 
mands of  life  renders  continuance  in  health  pos- 
sible. In  this  sense,  Freud  is  a  supporter  of  a 
systematic  enlightenment  of  children.^  The 
necessity  for  this  lies  in  the  fact  that  children 
often  show  great  interest  and  understanding  in 
the  affairs  and  problems  of  the  sexual  life.     This 

2  Compare  A.  Adler,  "Das  Zartlichkeitsbedurfnis  des  Kindes," 
Monatshefte  f.  Pddagogik  u.  Schulpolitik,  1908. 

8  Compare  the  detailed  discussion  of  the  problem  of  onanism 
under  neurasthenia  (Chapter  II). 

4  Lit.  No.  26. 


GENERAL  PROPHYLAXIS  233 

finds  expression  not  only  in  the  instinct  for  sexual 
investigation  of  children  which  leads  to  the  al- 
ready mentioned,  sometimes  very  disastrous  birth 
and  creation  phantasies  but  also  in  masked  form 
in  their  untiring  questioning,  which  education  has 
to  satisfy  intelhgently.  The  fear  that  the  child 
may  be  enlightened  prematurely  is  entirely  un- 
grounded; for  when  the  child  once  begins  to  in- 
quire, it  has  already  busied  itself  a  long  time  most 
intimately  with  the  sexual  problem;  experience 
teaches  that  it  is  injudicious  either  to  wish  to  si- 
lence or  lead  into  false  channels  this  interest  of 
the  child  once  it  is  awakened.  To  wish  to  hold 
back  the  sexual  instinct  of  the  child,  through  such 
concealment  could  only  lead  to  his  later  learning 
to  condemn  everything  sexual  as  something  vul- 
gar and  abhorrent.  If  one  seeks  to  deceive  them 
through  false  information  as  the  stork  legend, 
etc.,  then  when  they  penetrate  behind  this  un- 
truthfulness of  the  parents  or  teacher,  they  lose 
trust  and  respect  for  them  and  can  often  receive 
mistrust  as  a  character  trait  for  their  whole  lives. 
The  manner  of  sexual  enlightenment  Freud  has 
represented  as  a  gradually  progressive  and  really 
uninterrupted  instruction  for  which,  in  place  of 
the  parents  who  are  as  yet  unqualified  for  such  a 
task,  the  school  must  take  the  initiative.  The 
most  important  point  in  this  is  that  the  children 
should  never  get  the  idea  that  one  wishes  to  make 


234     FREUD'S  THEORY  OF  THE  NEUROSES 

the  affairs  of  the  sexual  life  any  more  of  a  secret 
for  them  than  anything  else  which  is  not  yet  com- 
prehensible to  their  understanding.  That  there 
is  opportunity  for  the  public  teacher  and  indeed 
for  the  clergy  to  make  use  of  the  Freudian  knowl- 
edge for  the  good  of  their  adherents  is  shown  by 
the  publications  of  the  Zurich  pastor  Pfister.^ 
Unfortunately,  the  parents  as  well  as  the  teachers 
of  to-day  still  lack  the  necessary  knowledge  of 
sexual  matters,  especially  in  relation  to  neurotic 
disturbances.  Especially  do  our  parents  and 
educators  lack  the  candor  to  discuss  the  sexual 
problem  from  which  they  in  great  part  openly 
suffer  with  the  children;  consequently  they  lack 
the  possibility  of  guarding  the  latter  against  sex- 
ual injuries  and  of  explaining  to  them  in  sufficient 
manner  all  allied  themes.  A  child  who  is  igno- 
rant of  sexual  matters  will  have  quite  a  different 
fate  from  one  who  has  been  instructed  in  these 
things.  We  perceive  therefore,  that  the  educa- 
tion in  the  affairs  of  sex  is  of  great  importance 

eQskar  Pfister,  "Psychoanalytische  Seelsorge  und  experi- 
mentelle  Moralpadagogik,"  Protestantische  Monatshefte,  13th 
year,  part  I,  M.  Heeksius,  Leipsic,  1909.  Same,  "Ein  Fall  von 
psychoanalytischer  Seelsorge  und  Seelenheilung,"  Monatschrift 
"Evangelische  Freiheit,"  9th  year,  Tubingen,  J.  C.  B.  Mohr,  1909. 
Same,  "Die  Psychoanalyse  als  wissenschaftliches  Prinzip  und 
seelsorgerliche  Methode,"  Ebenda,  10th  year,  1910.  Dr.  A. 
Muthmann  also  sought  to  interest  the  clergy  in  an  article  "Psy- 
chiatr.-theolog.  Grenzfragen,"  Halle  a.  d.  Saale,  Karl  Marhold, 
1907. 


GENERAL  PROPHYLAXIS  235 

not  only  in  the  prevention  of  the  neuroses  but  also 
for  the  whole  character  development  of  the  child. 
Therefore,  sexual  education^  is  essentially  the 
fundamental  problem  of  education  and  cannot  be 
separated  from  the  question  of  sexual  enlighten- 
ment. How  the  education  should  begin  or  how 
to  avoid  injurious  results  which  have  already  oc- 
curred is  a  subject  on  which  Freud  has  not  ex- 
pressed himself  in  detail,  since  he  considered  his 
field  to  be  rather  investigation  and  therapeutics 
than  pedagogy  and  reformation.  The  three  fol- 
lowing chief  view  points  for  sexual  education  in 
general  may  be  deduced  from  Freud's  works: 
In  a  first  period,  the  education  should  vigorously 
aid  the  suppression  of  the  normally  occurring  in- 
stinctive impulses  and  the  repression  of  wrong 
(perverse)  impulses  of  the  growing  child,  thus 
preventing  wrong  tendencies  and  disturbances  of 
development;  in  a  later  period,  it  would  have  to 
interfere  positively  and  educate  the  child  chiefly 
through  love;  in  a  third  period,  the  grown  up 
child  would  with  the  aid  of  his  own  parents  free 
himself  from  their  authority  and  establish  his  psy- 
chic and  social  iTidividuality. 

If  the  prophylaxis,  however,  is  to  become  ef- 
fective and  far-reaching,  wider  circles  must  be  in- 
terested in  the  problem.     For  in  affairs  of  pro- 

6  Compare  A.  Adler,  "Das  sexuelle  Problem  in  der  Erziehung," 
Die  neue  QeselUchaft,  1905. 


236  FREUD'S  THEORY  OF  THE  NEUROSES 

phylaxis,  the  individual  is  almost  powerless.  The 
whole  body  of  citizens  must  acquire  an  interest  in 
the  subject  and  give  their  consent  to  the  creation 
of  generally  observed  regulations.  At  present, 
we  are  far  removed,  however,  from  a  condition 
which  would  promise  a  remedy  and  can  therefore 
justly  make  our  civilization  and  cultural  mor- 
ality answerable  for  the  spread  of  the  neuroses. 
There  must  be  a  great  change  of  mind.  The  op- 
position of  a  generation  of  physicians  who  no 
longer  recall  their  youth  must  be  broken.  The 
haughtiness  of  the  fathers  who  do  not  gladly  de- 
scend to  the  level  of  ordinary  mortals  in  the  eyes 
of  their  children  must  be  overcome,  the  foolish 
bashf ulness  of  the  mothers  must  be  combated,  for 
whom  it  now  seems  hke  an  inscrutable  and  unde- 
served decree  of  fate  that  their  children  have  be- 
come nervous.  "Before  everything  else,  how- 
ever, there  must  be  opened  in  the  general  thought 
a  chance  for  the  discussion  of  the  sexual  problem ; 
one  must  be  able  to  speak  of  these  things  without 
being  pronounced  a  disturber  of  the  peace  or  a 
delver  in  the  vulgar  instinct.  And  there  remains 
enough  work  here  for  a  century  in  which  our 
civilization  must  learn  to  live  according  to  the  de- 
mands of  our  sexuality."  ^ 

TLit  No.  11. 


CHAPTER  X 

APPLICATION  OF  PSYCHO-ANALYSIS 

Importance  of  Psycho-Analysis  for  Medicine.  Im- 
portance for  the  Psychology  of  Normal  Individuals  and 
for  Normal  Psychology  (Unconscious,  Dream,  Wit). 
Psychopathology  of  Everyday  Life.  Elucidation  of 
the  Psychology  of  Psychopaths,  Criminals,  Artists, 
Poets  and  Geniuses  (Characterology).  Importance 
for  the  History  of  Culture  and  Folk-Psychology. 

It  is  an  indisputable  service  of  Freud's  to  have 
elaborated  psycho-analysis  to  a  method  which  is 
not  only  able  to  disclose  the  pathogenesis  and  con- 
tent of  mental  disorders  but  is  also  valuable  for 
their  treatment.  It  cannot  be  rejected  as  Uto- 
pian to  beheve  that  when  the  fundamental  prin- 
ciples of  the  neuroses  as  revealed  by  Freud  shall 
have  become  for  the  general  good  a  part  of  medi- 
cal knowledge  and  thereby  indirectly  a  part  of 
universal  knowledge,  the  frequency  of  the  neu- 
roses may  be  lessened.^  The  psycho-analytic 
recognition  of  the  nature  of  these  maladies,  of 
their  psycho-sexual  root  as  well  as  the  means  of 

1  Compare   Chr.   v.   Ehrenfels,   "Sexuales   Ober-  und  Unterbe- 
wusstsein,"  Polit.-anthropolog.  Revue,  II,  Part  6. 

237 


238     FREUD'S  THEORY  OF  THE  NEUROSES 

prophylaxis  to  which  they  point,  will  likewise 
work  together  to  allow  the  neuroses  to  appear 
only  in  plain  form.  Individuals  of  neurotic  dis- 
position will  have  to  renounce  the  representation 
of  their  symptoms  after  the  origin  and  sjonbolism 
of  these  shall  have  become  transparent.^  Per- 
haps indeed,  psycho-analysis  may  succeed  in  de- 
stroying the  germ  of  the  neurosis  in  childhood 
when  the  teacher,  entrusted  with  the  chief  points 
of  the  theory,  aids  in  the  prevention.  Psycho- 
analysis is  not,  however,  merely  a  method  for  in- 
vestigating disordered  minds  but  seems  to  be  des- 
tined to  become  perhaps  the  most  influential 
method  of  mental  investigation  in  general.  Psy- 
cho-analysis yields  such  far-reaching  explanations 
of  the  mechanism  of  mental  functioning  that  in 
contrast  to  a  certain  stagnation  in  the  official  psy- 
chology of  the  universities,  it  allows  an  especially 
hopeful  outlook.  The  ^'hopelessness  of  all  psy- 
chology," ^  which  P.  J.  Mobius  has  proclaimed, 
can  with  a  certain  degree  of  justification  be  ap- 
plied only  to  the  prevaihng  "consciousness-psy- 
chology" (Bewusstseinspsychologie),  while  the 
method  for  investigating  unconscious  mental 
processes  inaugurated  by  Freud  affords  an  out- 

2  Compare  Freud,  "Die  zukiinftigen  Chancen  der  Psychoanalyse," 
Lit  No.  41. 

3  P.    J.    Mobius,    "Die    Hoffnungslosigkeit    aller    Psychologic." 
Marhold,  Halle  a.  d.  Saale,  3  ed.  1907. 


APPLICATION  OF  PSYCHO-ANALYSIS      239 

look  which  is  full  of  promise  for  the  future.  The 
precise  psycho-analytic  method  can  replace  the 
speculations  of  metaphysics  which  have  remained 
essentially  unchanged  for  centuries  as  a  kind  of 
"metapsychology."  Psycho-analysis  has  brought 
forward  such  new  and  fundamental  principles 
regarding  forgetting  and  mental  obsession 
(Zwang),  which  is  so  closely  connected  with  the 
theory  of  the  will,  and  in  particular  has  placed  the 
determinism  of  all  mental  processes  on  so  broad  a 
basis  ^  that  from  this  point  an  especially  produc- 
tive scientific  period  will  take  its  origin.  It  has 
already  placed  the  fundamental  facts  of  mental 
processes  in  a  new  light.  Thus,  of  prime  impor- 
tance, are  revealed  the  eternally  acting  wishes  of 
the  mind,  the  ever-compelling  instinct  and  the 
continual  striving  after  pleasure  as  the  primary 
tendencies  of  the  mind.  Alongside  these  are  the 
mechanisms  of  repression,  condensation  and  dis- 
placement discovered  by  Freud ;  these  arise  from 
the  entirely  new  conception  concerning  the  invest- 
ment of  ideas  with  affects  and  that  the  two  are 
separable;  further  the  substitute  formations  and 
the  sublimation  which  is  so  important  in  the  his- 
tory of  culture,  all  these  afford  valuable  building 
stones  in  the  most  diverse  departments  of  psychol- 
ogy. Freud  has  thrown  light  into  isolated  de- 
partments of  general  psychology  by  his  detailed 

4  Compare  the  numerous  references  to  the  association  experiment. 


240     FREUD'S  THEORY  OF  THE  NEUROSES 

investigations  into  the  psycho-pathology  of  every- 
day life,  the  technique  of  wit  formation  and  the 
mechanism  of  dream  origin.  He  has  solved  that 
ancient  enigma  of  the  dream  and,  in  opposition  to 
the  consciousness-psychology,  has  brought  about 
the  enthronement  of  the  unconscious.  The  orig- 
inal perception  of  Freud's  of  the  close  connec- 
tion of  the  development  of  culture  to  the  suppres- 
sion and  saiblimation  of  instinct  has  so  much 
significance  in  the  history  of  evolution  of  human- 
ity and  of  individual  peoples  that  in  this  field  also 
much  work  and  fruitful  knowledge  is  yielded  by 
psycho-analysis.  The  fact  that  besides  the  life 
instinct  of  the  ego,  the  love-instinct  has  a  far- 
reaching  primordial  force,  which  cannot  fail  to 
injure  the  individual  if  it  succumbs  in  the  conflict 
of  these  two  fundamental  instincts,  is  likewise  of 
great  significance  for  the  development  of  culture. 
It  must  sound  very  consoling  to  men  to  hear  that 
degeneration  and  nervousness  are  not  inevitable 
results  of  cultural  progress  but  avoidable  and 
only  excrescences  of  the  same.  A  healthy  opti- 
mism and  a  broad  conception  of  life  remaining 
natural  in  spite  of  all  spiritualization  and  refine- 
ment which  will  not  completely  exclude  all  sensu- 
ousness  follow  naturally  this  enlightenment. 
The  results  of  Freud's  investigations  sound  a 
warning  to  civilized  man  of  to-day  that  the  origi- 
nal animal  part  of  his  nature  is  not  to  be  com- 


APPLICATION  OF  PSYCHO-ANALYSIS      241 

pletely  neglected  and  that  he  must  not  forget  that 
the  attainment  of  pleasure  for  the  individual  is 
not  to  be  eliminated  from  the  aims  of  our  culture.^ 
If  the  suppression  of  the  sexual  instinct  through 
its  peculiar  possibility  of  sublimation,  that  is  to 
say,  through  the  substitution  of  a  more  remote 
and  socially  more  valuable  cultural  aim  for  its 
original  goal  promotes  culture,  still,  a  certain  part 
of  its  impulse  has  a  right  to  a  direct  gratification, 
for  an  excess  of  repression  compels  a  turning 
away  from  reality  and  thereby  the  establishment 
of  the  neurosis.  It  should  be  here  expressly 
stated  that  Freud  is  perfectly  clear  on  the  point 
of  the  decisive  role  played  in  life  and  also  in  the 
neurosis  by  the  egotistic  or  ego  instincts  alongside 
of  the  sexual  instinct.  The  Freudian  doctrines 
emphasize  the  hitherto  neglected  point  of  view  of 
the  unconscious  mental  life  and  the  libidinous  im- 
pulses. The  detailed  investigation  of  the  ego  in- 
stincts which  is  still  to  be  done  in  exhaustive  fash- 
ion would  afford  supplementary  explanations  of 
the  neuroses,  especially  of  the  symptom  forma- 
tion. 

The  hysterical  mind  has  unveiled  itself  through 
psycho-analytic  investigation  as  merely  a  dis- 
torted image  of  the  normal  mind,  for  he  who  re- 
mains healthy  has  to  struggle  with  the  same  com- 

5  Compare  the  popular  book  of  P.  J.  Miiller,  "Geschlectsmoral 
und  Lebensgluck."    Copenhagen,  Tilge,  1909. 


242     FREUD'S  THEORY  OF  THE  NEUROSES 

plexes  that  cause  the  neurotic  to  fall  ill  (Jung). 
As  under  certain  combinations  of  conflicting 
forces,  the  neurosis  is  the  outcome  of  the  struggle, 
so  under  other  relations  of  these  mutually  war- 
ring forces,  other  results  may  ensue;  these  are 
especially  the  antisocial  types  of  psychopaths 
and  criminals  as  well  as  the  socially  superior,  as 
artists,  poets  and  men  of  genius.  The  character 
analysis  of  the  gifted,  especially  of  artistically  in- 
clined persons,  reveals  every  degree  of  combina- 
tion between  capability,  perversion  and  neurosis. 
The  psychology  of  criminals  has  not  yet  been 
elucidated  but  appears  to  offer  a  favorable  field 
of  investigation  by  this  method.^  Psycho-anal- 
ysis, especially  in  the  form  of  the  association  ex- 
periment, has  already  been  seriously  applied  in 
legal  practice  as  a  means  of  determining  the  con- 
dition of  facts  in  the  detection  of  a  guilty  con- 
science.'^ The  meaning  of  different  peculiar 
types  of  men  (odd  characters,  saints,  reformers)  ^ 
and  many  psychopathic  individuals  ^  is  explained 

»  Compare  Wulffen,  "Der  Sexualverbrecher."    Berlin,  1910. 

7  Freud,  "Tatbestandsdiagnostik  und  Psychoanalyse,"  Lit.  No.  24. 
Jung,  "die  psychologische  Diagnostik  des  Tatbestandes,"  Jur.- 
psych.  Grenzfragen,  1906.  Other  literature  in  E.  Rittershaus,  "Die 
Komplexforschung,"  Jour.  f.  Psych,  u.  Neur.,  Vol.  15,  1910. 

8  Hitschmann,  "Die  Werbekraft  der  Naturheilkunde,"  Wr.  klin. 
Rundschau,  1910. 

9  Otto  Gross,  "uber  psychopathische  Minderwertigkeit." 
Vienna,    Braumuller,    1909.    O.    Pftster,    "Die    Frommigkeit    des 


APPLICATION  OF  PSYCHO-ANALYSIS      243 

by  this  side  of  psychological  investigation,  often 
in  surprising  fashion.  Likewise,  an  illumination 
of  occultistic  ^^  and  hypnotic  ^^  phenomena  is  af- 
forded respecting  the  persons  who  are  interested 
in  these  things.  That  the  genius  is  named  here 
cannot  seem  strange  to  one  who  has  already 
gained  an  inner  understanding  of  these  things. 
The  psycho-analytic  investigations  seem  to 
justify  the  dictum  that  the  genius  represents  the 
noblest  outcome  of  the  overcoming  of  an  ab- 
normal hereditary  tendency,  whence  he  derives 
his  close  relationship  to  the  neurotic.  Rank  has, 
in  a  brief  paper,^^  sought  to  show  the  relations  of 
the  artistic  temperament  to  the  neurosis  and  came 
to  the  conclusion  that  especially  the  poet,  both  in 
the  mechanism  and  also  in  the  ultimate  tendency 
of  his  creations,  stands  very  near  the  psychoneu- 
rotic and  only  by  the  aid  of  his  artistic  talents  pro- 
tects himself  from  the  neurosis.  Stekel  ^^  and 
Sadger  have  undertaken  special  investigations  in 
this  direction.  The  latter  in  particular  has 
sought  to  interpret  the  lives  of  the  individual 

Grafen  Ludwig  von  Zinzendorf,"  Schr.  z.  angew.  Seelenkunde, 
No.  8,  1910. 

10  Jung,  "Zur  Psychologic  und  Pathologic  sog.  okkulter 
Phanomene."  Leipzic,  O.  Mutze,  1902.  Hitschmann,  "Zur  Kritik 
des  Hellsehens,"  Wr.  klin.  Rundschau,  1910. 

11  Ferenczi,  "'Intro jektion  und  tjbertragiing,"  Jahrb.,  I,  2,  1909. 
i2«Der  Kunstler."    Vienna,  H.  Heller,  1907. 

13  "Dichtung  und  Neurose."    Bergmann,  Wiesbaden,  1909. 


244f     FREUD'S  THEORY  OF  THE  NEUROSES 

poets,  as  C.  F.  Meyer/*  Lenau/^  Kleist^^  and 
others  psycho-analytically.  The  first  incitement 
to  the  application  of  information  regarding  the 
mind  gained  by  psycho-analysis  to  a  deeper  pene- 
tration into  the  mind  of  the  poet  was  put  forward 
by  Freud  in  connection  with  the  solution  of  the 
dream  problem  in  his  interpretation  of  Shake- 
speare's drama  of  Hamlet  ^^  in  which  he  could 
reveal,  in  connection  with  the  OEdipus  of  Soph- 
ocles, a  masked  form  of  the  universal  incest  com- 
plex.^^ 

A  penetrating  glimpse  of  the  secret  strata  of 
the  poetic  work  is  afforded  by  the  analysis  under- 
taken by  Freud  of  the  delusions  and  dreams  in 
W.  Jensen's  Gradiva/^  It  is  shown  there  that 
the  poet,  without  knowledge  of  dream  and  neu- 
rosis psychology,  can  still  create  his  bit  of  phan- 
tasy so  that  the  physician  can  analyze  it  like  a  real 
clinical  history.  From  this  follows  the  necessity 
for  the  conclusion  that  the  psycho-analyst  and  the 
poet  must  have  worked  from  the  same  sources, 
that  they  elaborated  the  same  subject  but  each 

i*"Eine  pathographische  Studie.'*    Bergmann,  Wiesbaden,  1908. 

15  "Aus  dem  Liebesleben  Nik.  Lenaus,"  Schr,  z.  angew.  Seelenk., 
No.  6,  1909. 

16  Bergmann,  Wiesbaden,  1910. 

17  Traumdeutung,  2d  ed.,  page  187. 

18  The  detailed  proof  for  this,  E.  Jones  has  brought  forward  in 
"The  CEdipus-Complex  as  an  Explanation  of  Hamlet's  Mystery" 
(Amer.  Journal  of  Psychology,  Jan.,  1910.) 

i»  Schriften  zur  angewandten  Seelenkunde,  Part  I. 


APPLICATION  OF  PSYCHO-ANALYSIS      245 

with  a  different  method;  the  agreement  in  results 
seems,  therefore,  to  warrant  the  conclusion  that 
both  have  worked  correctly.  The  method  of  the 
analyst  consists  in  the  conscious  pbservation  of 
the  abnormal  mental  processes  in  others  in  order 
to  guess  the  rules  and  be  able  to  formulate  them. 
The  poet  goes  at  it  differently :  he  directs  his  at- 
tention to  the  unconscious  in  his  own  soul,  listens 
to  the  possibilities  of  development  of  the  same 
and  allows  it  artistic  expression  instead  of  sup- 
pressing it  by  conscious  criticism.  Thus,  he  ex- 
periences out  of  himself  what  the  analyst  learns 
from  others:  namely,  what  rules  the  activity  of 
this  unconscious  must  follow;  but  he  need  not 
formulate  these  rules,  not  once  clearly  recognize 
them,  they  are  as  a  result  of  his  intelligence  in- 
corporated in  his  creations.  The  analyst  de- 
velops these  rules  by  analysis  of  the  poems  as  he 
has  detected  them  in  cases  of  real  illness ;  the  con- 
clusion seems  inevitable :  either  both  the  poet  and 
the  physician  have  misunderstood  the  unconscious 
in  similar  manner  or  both  have  understood  it  cor- 
rectly. 

The  sources  of  the  poetic  phantasy  arise  not 
far  from  those  of  the  dream  and  day-dream  of 
people  and  Freud  has  shown  in  his  lecture  "Der 
Dichter  und  das  Phantasieren"  ^^  (Poet  and 
Phantasy)  that  the  material  of  the  narrating  poet 

20  Lit.  No.  31. 


246  FREUD'S  THEORY  OF  THE  NEUROSES 

(romance) ,  as  far  as  it  arises  from  free  invention, 
betrays  its  genesis  by  its  analogous  structure  to 
the  day-dream.  These  phantasies  are  indeed,  by 
the  poetic  technique  which  in  individual  cases  is 
not  demanded,  divested  of  their  purely  individual 
interest  and  transformed  to  general  sources  qf 
pleasure.  ^-N.^^ 

Recently,  Freud  has  published  a  psycho-ana- 
lytic study  on  the  peculiar  mental  physiognomy 
of  one  of  the  greatest  artists,  "Eine  Kindheitser- 
innerung  des  Leonardo  da  Vinci"  ^^  (A  Child- 
hood Memory  of  Leonardo  da  Vinci) ,  and  there- 
with given  an  example  of  the  influence  of  psycho- 
analysis on  biography.  The  investigation  gives, 
proceeding  from  the  interpretation  of  a  childhood 
phantasy,  an  original  and  surprising  insight  into 
the  conditions  of  the  artistic  work  of  this  universal 
genius.  Here  the  attempt  is  made  anew  to  de- 
rive from  the  exceptional  case  of  one  of  the  great- 
est geniuses  of  mankind  one  of  the  most  impor- 
tant propositions  of  psycho-analytic  science, 
namely,  the  fundamental  and  definite  importance 
for  the  whole  course  of  mental  development  of  all 
the  first  impressions  of  childhood,  the  later  force 
of  which  can  be  essentially  weakened  by  no  later 
experience,  no  matter  how  intense.  The  subse- 
quent effect  is  explained  by  the  fact  that  these 
first  impressions  have  given  sensuous  pleasure. 

zi8chr,  z.  angew.  Seelenkunde,  No.  7,  1910. 


APPLICATION  OF  PSYCHO-ANALYSIS      247 

Infantilism  and  sexuality,  which  are  disclosed  by 
the  Freudian  investigations  as  the  chief  com- 
ponents of  the  neuroses,  show  themselves  further 
to  be  the  directing  streams  in  the  development  of 
every  character,  both  of  the  exceptional  (genius) 
and  of  the  normal.  Thereby  is  the  way  prepared 
for  a  kind  of  characterology  which  will  perhaps 
be  in  a  position  to  set  up  certain  types  and  to 
bring  the  development  of  these  into  close  connec- 
tion with  quite  definite  expressions  of  certain  in- 
stinctive activities.  For  such  a  formation  of  final 
character  from  definite  constitutional  instinctive 
impulses  and  the  later  fate  of  these,  Freud  has 
laid  down  a  formula  according  to  which  the  char- 
acter traits  which  remain  are  either  unchanged 
continuations  of  original  instincts,  sublimations 
of  the  same  or  reactions  against  them.^^ 

It  is  conceivable  that  such  important  results 
for  the  comprehension  of  mental  life  may  not  re- 
main limited  to  the  psychology  of  isolated  indi- 
viduals and  it  is  an  indirect  proof  of  the  correct- 
ness of  the  Freudian  theory  that  these  have 
proved  so  very  fruitful  in  the  field  of  folk-psy- 
chology. In  the  ''Schriften  zur  angewandten 
Seelenkunde"  (Papers  on  Applied  Psychology), 
edited  by  Freud,  are  some  works  along  this  line. 
Riklin  could  show  in  "Wunscherfiillung  und 
Sj^mbolik"  that  the  wish-fulfilling  and  symbolism 

22  Lit.  No.  29. 


248     FREUD'S  THEORY  OF  THE  NEUROSES 

which  Freud  had  discovered  in  the  dream  and 
neurosis  was  also  active  in  legends  (part  2, 1907) . 
Abraham  has  shown  in  a  study  on  folk-psychol- 
ogy, "Traum  und  Mythus"  (Dream  and  Myth) 
(part  4,  1908),  that  the  fundamental  meaning  of 
the  CEdipus  tales  as  given  by  Freud  also  gives  ex- 
pression to  the  same  psychological  facts  in  folk- 
myths  ;  Rank  in  a  limited  group  of  myths,  "My- 
thus von  der  Geburt  des  Helden"  (Myths  of  the 
Birth  of  Heroes)  (part  5,  1909),  demonstrated 
the  value  of  the  detailed  knowledge  gained  by 
psycho-analysis  for  the  deeper  understanding  of 
myth  formation  and  myth  interpretation. 

Further,  Freud  has  endeavored  to  illuminate  ^^ 
from  the  psycho-analytic  standpoint  the  most  im- 
portant performance  of  the  folk-mind  in  addition 
to  the  myth  and  legend  creation,  namely  religion, 
on  the  basis  of  certain  apparent  similarities  be- 
tween definite  obsessional  acts  of  those  with  obses- 
sional neurosis  and  the  forms  of  religious  customs, 
and  has  come  to  the  conclusion  on  the  ground  of 
certain  agreements  and  analogies  that  the  obses- 
sional neurosis  is  a  pathological  counterpart  of  the 
religious  structure;  we  may  call  the  neurosis  an 
individual  religious  practice,  the  religion,  an  uni- 
versal obsessional  neurosis.  Here  the  complexes 
in  the  sense  of  Jung  lose  as  you  might  say  their  pa- 
thogenic activity  ''since  they  become  universal." 

23  "Zwangshandlungen  und  Religionsiibung,"  Lit.  No,  25. 


APPLICATION  OF  PSYCHO-ANALYSIS      249 

The  individual  root  of  the  belief  in  God  Freud 
has  disclosed  in  the  intimate  connection  with  the 
father-complex;  the  personal  God  is  psychologi- 
cally no  other  than  an  enlarged  father  and  psycho- 
analysis brings  daily  before  our  eyes  how  youth- 
ful persons  lose  their  religious  faith  as  soon  as  the 
authority  of  the  father  is  broken  in  them.  Bio- 
logically, religion  goes  back  to  the  helplessness  of 
the  little  human  child,  which  when  it  has  later 
recognized  its  weakness  against  the  great  powers 
of  life,  seeks  to  deny  its  position  just  as  in  child- 
hood it  feels  and  seeks  to  deny  its  disconsolate- 
ness  by  regressive  renewing  of  infantile  protect- 
ive measures.^^  In  ultimate  analysis,  religion 
seems  like  the  delusion,  dream  and  neurosis  to  be 
an  attempt  on  the  part  of  us  human  beings  to 
make  up  for  the  deficiency  of  reality  which  we 
find  quite  generally  unsatisfying  by  the  produc- 
tion of  wish-fulfillment. 

The  brief  resume  given  in  this  chapter  of  the 
fruitful  activity  of  psycho-analysis  applied  to 
other  fields  of  mental  science  shows  that  we  have 
here  more  than  a  purely  medical  instrument  and 
since  in  all  these  fields  as  yet  only  the  first  begin- 
nings in  life  have  been  touched  upon,  so  with  the 
constantly  growing  number  of  co-workers  from 
other  fields  of  science,  further  elaboration  is  to 
be  expected. 

24  Lit.  No.  39. 


CHRONOLOGICAL  REVIEW  OF 

FREUD'S  WRITINGS  ^  FROM 

1893  TO  1910 

1.  liber    den    psychischen    Mechanismus    hysterischer 

Phanomene.  By  Dr.  Josef  Breuer  and  Dr.  Sig- 
mund  Freud  in  Vienna.  Neurologisches  Zen- 
tralblatt,  1893,  Nr.  1  and  2,  also  reprinted  as 
introduction  to  the  "Studien  Uber  Hysteric," 
1895,  and  in  the  "Sammlung  kleiner  Schriften 
zur  Neurosenlehre  aus  den  Jahren  1893-1906" 
(Kl.  Schr.  I).  F.  Detiticke.  Vienna  and  Leip- 
zic,  1906. 

2.  Quelques  considerations  pour  une  6tude  comparative 

des  paralysies  motrices  organiques  et  hysteri- 
ques.  Archives  de  Neurologic,  1893,  Nr.  77. 
(Also  Kl.  Schr.  I.) 

3.  Die  Abwehrneuropsychosen.     Attempt  at  a  psycho- 

logical theory  of  acquired  hysteria,  many  pho- 
bias and  obsessions  and  certain  hallucinatory 
psychoses.  Neurologisches  Zentralblatt,  1894, 
Nr.  10  and  11.     (Also  Kl.  Schr.  I.) 

4.  Uber  die  Berechtigung,  von  der  Neurasthenic  einen 

bestimmten  Symptomenkomplcx  als  "Angstneu- 
rose"  abzutrennen.  Neurologisches  Zentral- 
blatt, 1895,  Nr.  %     (Also  Kl.  Schr.  I.) 

5.  Studien  Uber  Hysteric.     By  Dr.  Josef  Breuer  and 

Dr.   Sigmund  Freud     Leipzic  and  Vienna,  F. 

1  Compare  also  Abraham's  bibliography  of  Freud's  writings  in 
the  Jahrbuch  fiir  psychoanalytitche  und  psychopathologische 
Forschungen,  VoL  I,  1909. 

251 


252  CHRONOLOGICAL  REVIEW 

Deuticke,  1895;  2,  unchanged  edition,  1909. 
Parts  of  Freud's  share  in  this  book  enlarged  by 
some  later  papers  on  hysteria  have  been  trans- 
lated into  English  by  Dr.  A.  A.  Brill:  "Selected 
Papers  on  Hysteria  and  other  Psychoneuroses" 
by  S.  Freud,  Nr.  4  of  the  "Nervous  and  Mental 
Disease  Monograph  Series,"  New  York,  1910. 

6.  Obsessions  et  Phobies.     Leur  Mecanisme  psychique 

et  leur  etiologie.  Revue  neurologique,  III, 
1895.  (Also  Kl.  Schr.  I.)  (German  transla- 
tion: Wiener  kl.  Rundschau,  1895.) 

7.  Zur  Kritik  der  "Angstneurose."     Wiener  kl.  Rund- 

schau, 1895.     (Also  KL  Schr.  L) 

8.  Weltere   Bemerkungen   Uber    die   Abwehmeuropsy- 

chosen.  Neurologisches  Zentralblatt,  1896, 
Nr.  10.     (Kl.  Schr.  L) 

9.  L'heredite  et  I'etiologie  des  Nevroses.     Revue  neu- 

roL,  IV,  1896.     (Kl.  Schr.  I.) 

10.  Zur  Atiologie   der   Hysterie.     Wiener   kl.   Rund- 

schau, 1896,  Nr.  22-26.     (Kl.  Schr.  I.) 

11.  Die    Sexualitat    in    der    Atiologie    der    Neurosen. 

Wiener  kl.  Rundschau,  1898,  Nr.  2,  4,  5,  7. 
(Kl.  Schr.  L) 

12.  Zum  psychischen  Mechanismus  der  Verges slichkeit. 

Monatsschrift  f.  Psychiatrie  u.  Neurologie,  Vol. 
4,  1898.  Reprinted  in  "Zur  Psychopathologie 
des  Alltagslebens." 

13.  Uber   Deckerinnerungen.     Ebenda,   Vol.    6,   1899. 

(Also  "Alltag.") 

14.  Die    Traumdeutung.     F.    Deuticke,    Leipzic    and 

Vienna,  1900;  2d  enlarged  edition,  1909. 

15.  Uber  den  Traum.     Wiesbaden,   J.   F.   Bergmann, 

1901.  (Grenzfragen  des  Nerven-  und  Seelen- 
lebens,  edited  by  Lowenfeld  and  Kurella.) 

16.  Zur    Psychopathologie     des     Alltagslebens.     Uber 

Vergessen,  Versprechen,  Vergreifen,  Aberglaube 


CHRONOLOGICAL  REVIEW  253 

und  Irrtum.  Monatsschrift  f.  Psychiatric  und 
Neurologic,  Vol.  10,  1901.  In  book  form:  Ber- 
lin, S.  Kargcr,  1904;  2d  enlarged  edition,  1907; 
3d  enlarged  edition,  1910.  Translated  into 
Russian  by  Dr.  B.  Medem,  1910. 

17.  Die    Frcudsche    psychoanalytischc    Methodc.     In 

Lowcnfeld :  "Psychische  Zwangscrschcinungen," 
1904.     (Kl.  Schr.  I.) 

18.  Uber  Psychothcrapic.     Wiener  med.  Prcsse,  1905, 

Nr.  1.     (KL  Schr.  L) 

19.  Der  W^itz  und  seine  Beziehung  zum  Unbcwusstcn. 

F.  Dcuticke,  Vienna  and  Leipzic,  1905. 

20.  Drei   Abhandlungen   zur   Sexualtheorie.     F.   Deu- 

ticke,  Vienna  and  Leipzic,  1905.  2d  essentially 
unchanged  edition,  1910. 

21.  Bruchstiick  einer  Hysterieanalyse.     Monatsschr.  f. 

Psychiatric  u.  Neurologic,  VoL  18,  Parts  4  and 
5,  1905.     (KL  Schr.  II.) 

22.  Meine  Ansichten  iiber  die  Rolle  der  Sexualitat  in 

der  Atiologic  der  Neurosc.  In  Lowcnfeld: 
"Sexualleben  u.  Nervenlciden,"  4th  ed.,  1906. 
(KL  Schr.  L) 

23.  Sammlung  kleincr  Schriften  zur  Neurosenlchre  aus 

den  Jahren  1893  to  1906.  Vienna  and  Leipzic, 
F.  Deuticke,  1906.     (Kl.  Schr.  L) 

24.  Tatbestandsdiagnostik    und    Psychoanalyse.     Ar- 

chiv  f,  Kriminalanthropologic  und  Kriminalistik 
by  Gross,  Vol.  26,  1906.     (KL  Schr.  II.) 

25.  Zwangshandlungen      und      Rcligionsiibung.     Zeit- 

scrift  f.  Rcligionspsychologie,  Vol.  I,  Part  1, 
1907.     (Kl.  Schr.  II.) 

26.  Zur  sexuellen  Aufklarung  der  Kinder.     ^'Soziale 

Medizin  und  Hygiene,"  Vol.  II,  1907.  (KL 
Schr.  IL) 

27.  Der  Wahn  und  die  Traumc  in  W.  Jensens  "Gra- 

diva."     Schriften     zur     angewandten     Scelen- 


254  CHRONOLOGICAL  REVIEW 

kunde,  edited  by  Prof.  Dr.  Sigm,  Freud,  Part  I, 

Leipzic  and  Vienna,  F.  Deuticke,  1908. 
£8.  Hysterische  Phantasien  und  ihre  Beziehung  zur  Bi- 

sexualitat.     Zeitschr.  f.  Sexualwissenschaft,  Nr, 

I,  Part  1,  1908.     (KL  Schr.  11.) 
29.  Charakter      und      Analerotik.     Psychiatr.-neurol. 

Wochenschr.,  9th  Year,  Nr.  52,  1908.     (Kl. 

Schr.  II.) 
80.  Die  "kulturelle"  Sexualmoral  und  die  moderne  Ner- 

vositat.     "Sexual-probleme,"      der     Zeitschrift 

"Mutterschutz"  neue  Folge.     4th  Year,  1908. 

(Kl.  Schr.  IL) 

31.  Der  Dichter  und  das  Phantasieren.     Neue  Revue, 

1st  Year,  2d  part  of  March,  1908.     (Kl.  Schr. 

•    ^^ 

32.  Uber  infantile  Sexualtheorien.     *'Sexualprobleme," 

4th  Year,  1908.     (Kl.  Schr.  IL) 

33.  Allgemeines   liber  den  hysterischen  Anfall.     Zeit- 

schrift f.  Psychotherapie  und  med.  Psychologie, 
1st  year,  1909.     (Kl.  Schr.  II.) 

34.  Sammlung    kleiner    Schriften    zur    Neurosenlehre. 

2d  ed.,  1909.  Vienna  and  Leipzic,  F.  Deuticke. 
(Kl.  Schr.  IL) 

35.  Analyse   der   Phobie   eines    fiinfjahrigen   Knaben. 

Jahrbuch  f.  psychoanalytische  und  psycho- 
pathologische  Forschungen.  Edited  by  Prof. 
Dr.  E.  Bleuler  and  Prof.  Dr.  S.  Freud.  Special 
editor,  Dozent  Dr.  C.  G.  Jung,  Vol.  I,  1909. 
F.  Deuticke. 

36.  Bemerkungen  iiber  einen  Fall  von  Zwangsneurose. 

Ebenda. 

37.  Uber  Psychoanalyse.     Five  lectures  delivered  at 

the  20  year  anniversary  of  Clark  Univ.,  Wor- 
cester, Mass.,  Sep.,  1909.  Leipzic  and  Vienna, 
t,  Deuticke,  1910. 

38.  Die  psychogene  Sehstorung  in  psychoanalytischer 


CHRONOLOGICAL  REVIEW  255 

Auffassung.  Arztliche  Standeszeitung,  1910, 
Nr.  9. 

39.  Eine  Kindheitserinnerung  des  Leonardo  da  Vinci. 

7th  Part  of  the  Schr.  zur  angew.  Seelenkunde. 
Vienna  and  Leipzic,  1910. 

40.  Uber  den  Gegensinn  der  Urworte.     Review  of  the 

book  of  same  name  by  Dr.  phil.  Karl  Abel, 
(1884)  Jahrb.,  Vol.  II,  Part  1,  1910. 

41.  Die  zukiinftigen  Chancen  der  Psychoanalyse.     Zen- 

tralblatt  f.  Psychoanalyse,  1910,  Part  1. 
Edited  by  Prof.  Dr.  S.  Freud.  Spec,  editors. 
Dr.  A.  Adler  and  Dr.  W.  Stekel.  Pub.  J.  F. 
Bergmann,  Wiesbaden. 

FREUDIAN  LITERATURE  IN  ENGLISH 

A.  A.  Brill:  Psychological  Factors  in  Dementia 
Praecox,  Journal  of  Abnormal  Psychology,  1908.  A 
Case  of  Schizophrenia  (Dementia  Prascox),  Amer. 
Journal  of  Insanity,  July,  1909.  Freud's  Conceptions 
of  the  Psychoneuroses,  Med.  Record,  Dec,  1909.  A 
Contribution  to  the  Psychopathology  of  Everyday  Life, 
Psychotherapy,  1909.  Dreams  and  their  Relation  to 
the  Neurosis,  N.  Y.  Med.  Journal,  Apr.,  1910.  The 
Anxiety  Neuroses,  Journal  of  Abnormal  Psychology, 

1910.  Freud's  Theory  of  Wit,  Journal  of  Abnormal 
Psychology,  1911.  Psychological  Mechanisms  of  Par- 
anoia, N.  Y.  Med.  Journal,  Dec,  1911.  Freud's  The- 
ory of  the  Compulsion  Neurosis,  Amer.  Medicine,  Dec, 

1911.  Hysterical  Dreamy  States;  their  Psychological 
Mechanism,  N.  Y.  Med.  Journal,  May,  1912.  A  Few 
Remarks  on  the  Technique  of  Psychoanalysis,  Med.  Re- 
view of  Reviews,  Apr.,  191S.  The  Only  or  Favorite 
Child  in  Adult  Life,  N.  Y.  State  Med.  Journal,  Aug., 

1912.  Anal  Eroticism  and  Character,  Journal  of  Ab- 
normal  Psychology,   Aug.-Sep.,   1912.     The   CEdipus 


v/ 


256  CHRONOLOGICAL  REVIEW 

Complex ;  its  Relation  to  the  Psychoneuroses,  Neuroses 
and  Psychosexual  Impotence,  N.  Y.  Med.  Journal,  Oct., 
1912.  Psycho-analysis;  its  Theories  and  Practical 
Application  (Book),  Saunders  Pub.  Co.,  Phila.,  1912. 

Ferenezi:  The  Psycho-analysis  of  Dreams,  Amer. 
Journal  of  Psychology,  Apr.,  1910. 

Freud:  Selected  Papers  on  Hysteria  and  other  Psy- 
choneuroses, Translation  by  Dr.  A.  A.  Brill  (Journal 
of  Nervous  and  Mental  Disease  Monograph  Series), 
2d  ed.,  1912.  The  Origin  and  Development  of  Psycho- 
analysis, Amer.  Journal  of  Psychology,  Apr.,  1910. 
Three  Contributions  to  the  Sexual  Theory.  Transla- 
tion by  Dr.  A.  A.  Brill  (Journal  of  Nervous  and  Men- 
tal Disease  Monograph  Series),  1910.  Freud's  Inter- 
pretation of  Dreams,  Translation  by  Dr.  Brill,  Mac- 
millan  Co.,  N.  Y.,  and  Geo.  Allen,  London,  1912. 

Trigant  Burrow:  Freud's  Psychology  in  its  Relation 
to  the  Neuroses,  American  Journal  of  the  Medical 
Sciences,  June,  1911.  Some  Psychological  Phases  of 
Medicine,  Journal  of  Abnormal  Psychology,  August- 
September,  1911.  Conscious  and  Unconscious  Menta- 
tion from  the  Psychoanalytic  Viewpoint,  Psychological 
Bulletin,  Vol.  IX,  No.  4,  Apr.  15,  1912.  Psychology 
and  Society,  Journal  of  Abnormal  Psychology,  Jan.-^ 
Feb.,  1913. 

Ernest  Jones:  Rationalization  in  Everyday  Life, 
Journal  of  Abnormal  Psychology,  Au^.-Sep.,  1908. 
Psycho-analysis  in  Psychotherapy,  Journal  of  Abnor- 
mal Psychology,  June- July,  1909.  Remarks  on  a  Case 
of  Complete  Auto-Psychic  Amnesia,  Journal  of  Abnor- 
mal Psychology,  Aug.-Sep.,  1909.  Psycho-analytic 
Notes  on  a  Case  of  Hypomania,  Amer.  Journal  of  In- 
sanity, Oct.,  1909.  On  the  Nightmare,  Amer.  Journal 
of  Insanity,  Jan.,  1910.  The  OEdipus  Complex  as  an 
Explanation  of  Hamlet's  Mystery,  Amer.  Journal  of 
Psychology,  Jan.,  1910.     Freud's  Psychology,  Psycho- 


CHRONOLOGICAL  REVIEW  257 

logical  Bulletin,  Apr.,  1910.  Freud's  Theory  of 
Dreams,  Amer.  Journal  of  Psychology,  Apr.,  1910. 
The  Psycho-analytic  Method  of  Treatment,  Journal  of 
Nervous  and  Mental  Disease,  May,  1910.  The  Mental 
Characteristics  of  Chronic  Epilepsy,  Maryland  Med. 
Journal,  June,  1910.  The  Therapeutic  Effect  of  Sug- 
gestion, Canadian  Med.  and  Surg.  Journal,  Feb.,  1911. 
Papers  on  Psycho-analysis,  Baillere,  Tindall  &  Cox, 
London,  1912. 

Jung :  The  Psychology  of  Dementia  Prascox.  Trans- 
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